GI A + H Flashcards
the transpyloric plane exists at what vertebral level
L1
the subcostal plane exists at what vertebral level
L3
the transtubercular plane exists at what vertebral level
L5
the interspinous plane exists at what vertebral level
S2
neurovascular bundles in the abdominal wall run between which muscular layers
transversus abdominis
internal oblique
name the superficial lymph nodes that drain the abdomen and thorax as well as the landmark that delineates to which nodes lymph will drain
the transumbilical plane is the demarcating feature
above the transumbilical plane: axillary and parasternal lymph nodes
below the transumbilical plane: superficial inguinal lymph nodes
identify the deep lymph nodes that drain the abdomen
external iliac nodes
common iliac nodes
lumbar (caval or aortic nodes)
identify the venous drainage of the abdomen
thoracoepigastric vein
peri-umbilical vein
superficial epigastric vein
what forms the median umbilical fold?
Median umbilical ligament
remnant of urachus
what forms the medial umbilical fold?
medial umbilical ligament
remnant of obliterated umbilical arteries
what forms the lateral umbilical folds?
inferior epigastric arteries and veins
the supravesicular fossa is defined by what abdominal features
median umbilical fold and
medial umbilical fold
the medial inguinal fossa is defined by what abdominal features
medial umbilical fold and
lateral umbilical fold
the lateral umbilical fossa is defined by what abdominal features
lateral umbilical fold and
lateral body wall
the deep inguinal ring lies in what fascial layer?
transversalis fascia
what makes up the posterior wall of the inguinal canal (lateral 1/3 to medial 1/3/superficial ring)
transversalis fascia
transversalis fascia
conjoint tendon plus reflected inguinal ligament
what makes up the anterior wall of the inguinal canal (lateral 1/3 to medial 1/3)
internal oblique + lateral crus of external oblique external oblique aponeurosis (lateral crus and intercrural fibers) external oblique (intercrural fibers) with the aponeurosis continuing as external spermatic fascia
what makes up the roof of the inguinal canal (lateral 1/3 to medial 1/3)
transversalis fascia
muscluo-aponeurotic arches (Internal Oblique and T.A.)
medial crus of external oblique
what makes up the floor of the inguinal canal (lateral 1/3 to medial 1/3)
iliopubic tract
inguinal ligament
lacunar ligament
parietal peritoneum is sensitive to what stimuli?
pressure, pain, temperature
visceral peritoneum is sensitive to what stimuli?
stretch and chemical irritation
what is the anterior boundary of the epiploic foramen?
hepatoduodenal ligament and portal triad
what is the posterior boundary of the epiploic foramen?
inferior vena cava
right crus of diaphragm
what is the superior boundary of the epiploic foramen?
caudate lobe of liver
what is the inferior boundary of the epiploic foramen?
1st part of the duodenum
list the different ligaments that comprise the greater omentum
gastrophrenic ligament
gastrosplenic ligament
gastrocolic ligament
list the different ligaments that comprise the lesser omentum
gastrohepatic ligament hepatoduodenal ligament (contains portal triad)
what structures are anterior to the lesser sac
lesser omentum
stomach
gastrocolic ligament
what structures are posterior to the lesser sac
pancreas
left suprarenal gland
left kidney
what structures are superior to the lesser sac
liver
diaphragm
what structures are inferior to the lesser sac
transverse mesocolon
1st part of duodenum
what structures are to the left of the lesser sac
hilum of spleen
gastrosplenic ligament
what structures are to the right of the lesser sac
epiploic foramen opens into greater sac
list the structures contained within the supracolic compartment
stomach
liver
spleen
list the structures contained within the infracolic compartment
small intestine
ascending colon
descending colon
what allows communication between the infracolic and supracolic compartments
paracolic gutters
the tail of the pancreas is at what vertebral level?
L1
the head of the pancreas is located at what vertebral level?
L2
what lies anterior to pancreas
lesser sac
stomach
what lies posterior to pancreas
aorta IVC splenic vein bile duct right crus of diaphragm left kidney and vessels left suprarenal gland SMV
what lies to the right of the pancreas
2nd part of duodenum
what lies to the left of the pancreas
spleen
what lies inferior to the pancreas
3rd part of duodenum
In the portal - caval anastomoses, describe the esophageal vein anastomosis
portal - esophageal v. from left gastric vein
caval - esophageal v. from azygos vein
in the portal - caval anastomoses, describe the umbilical anastomosis
portal - para-umbilical vein
caval - inferior epigastric vein
in the portal - caval anastomoses, describe the rectal anastomosis
portal - superior rectal
caval - inferior rectal and middle rectal
in the portal - caval anastomoses, describe the visceral anastomosis
portal - inferior and superior mesenteric veins
caval - posterior abdominal wall veins and diaphragm veins
what is renal vein entrapment syndrome?
AKA nutcracker syndrome
downward traction of SMA can compress left renal vein (can also compress 3rd part of duodenum)
list the components of the foregut
esophagus stomach duodenum (first and second parts) liver pancreas biliary aparatus gallbladder
list the components of the midgut
duodenum (second, third and fourth parts) jejunum ileum cecum appendix ascending colon transverse colon (proximal 2/3)
list the components of the hindgut
transverse colon (distal 1/3) descending colon sigmoid colon rectum anal canal (above pectinate line)
what is the origin of the parasympathetic innervation of the hindgut
pelvic splanchnic nerves
describe the sympathetic innervation of the foregut
preganglionics: thoracic splanchnic nerves (T5-9; greater splanchnic nerve)
postganglionic cell bodies: celiac ganglion
describe the sympathetic innervation of the midgut
preganglionics: lesser and least splanchnic nerves
postganglionic cell bodies: superior mesenteric ganglion
describe the sympathetic innervation of the hindgut
preganglionics: lumbar splanchnic nerves (L1-L2)
postgnaglionic cell bodies: inferior mesenteric ganglion
what sort of vascular changes and GI motility changes are elicited by sympathetic activity
vasoconstriction, inhibition of peristalsis
pelvic splanchnic nerves are derived from anterior rami of spinal nerves from what levels?
S2-S4
describe the two principal components of the enteric nervous system of the GI tract
myenteric plexus - motility
submucosal plexus - secretion, absorption
describe the various components of the parasympathetic division of the ANS in the GI tract
anterior/posterior vagal trunks
pelvic splanchnic nerves
autonomic plexuses with periarterial plexuses
enteric nervous system
list the things that touch the stomach anteriorly
anterior abdominal wall
diaphragm
left lobe of the liver
list the things that touch the stomach posteriorly
diaphragm spleen left suprarenal left upper kidney pancreas transverse colon transverse mesocolon omental bursa
list the features of the first part of the duodenum
hepatoduodenal ligament
list the features of the second part of the duodenum
retroperitoneal
bile duct and pancreatic ducts enter at duodenal papilla
list the features of the third part of the duodenum
retroperitoneal
superior mesenteric artery and vein + root of mesentery cross anteriorly
head of pancreas is superior
list the features of the fourth part of the duodenum
becomes intraperitoneal
posterior: left margin of aorta and psoas major muscle
suspensory ligament of duodenum
is the jejunum intraperitoneal or retroperitoneal
intra
is the ileum intraperitoneal or retroperitoneal
intra
is the duodenum intraperitoneal or retroperitoneal
1 -
2- retro
3 - retro
4 - intra
where is the jejunum located in the 4 quadrant system
left upper quadrant
where is the ileum located in the 4 quadrant system
right lower quadrant
3 bands of longitudinal muscle on the large intestine are called what
tenia coli
the product of tenia coli are
haustra/sacculations
what structures lie anterior to the spleen
stomach
tail of pancreas
what structures lie posterior to the spleen
diaphragm
what structures lie inferior to the spleen
left colic flexure
what structures lie medial to the left spleen
left kidney
list the lobes of the liver
left
right
caudate
quadrate
where does the gallbladder contact the anterior abdominal wall
9th costal cartilage
in general the organization of the digestive tube can be organized into 4 layers. what are those 4 layers
mucosa
submucosa
muscularis externa
serosa/adventitia
what are the subcomponents of the mucosa, generally speaking
epithelium
lamina propria
muscularis mucosae
what are the subcomponents of the muscularis externa in general when referring to the digestive tract
inner circular layer
outer longitudinal layer
what layer of the digestive tract supplies the mucosa with nerve vascular and lymphatic supply
submucosa
the nerves and vasculature supplying the muscularis externa lie in what layer
between the inner circular and outer longitudinal layers
visceral afferent cell bodies are present in what layer of the GI tract
muscularis externa (plexus of auerbach/myenteric plexus)
sympathetic efferent fiber cell bodies are present in what layer of the GI tract
submucosa (meissner’s plexus/submucosal plexus)
presynaptic parasympathetic fibers run in what layer of the GI tract
muscularis externa myenteric plexus (auerbach's plexus)
the epithelium of the esophagus is best described as what
non-keratinized stratified squamous epithelium
describe the muscularis mucosae of the esophagus
not present mostly
becomes present near the stomach
what sort of glands are present in the esophagus
mucosa –> cardiac esophageal glands in the lamina propria
submucosa –> tubuloacinar glands (esophageal glands proper)
describe the epithelium of the stomach
simple columnar without goblet cells
GERD can lead to what sort of esophageal abnormality?
Barrett Esophagus
rugae are most present where
greater curvature
pylorus
describe the muscularis mucosae of the stomach
in the esophagus its almost nonexistent but in the stomach there is an inner circular layer and outer longitudinal layer
describe the layering of the muscularis externa in the stomach
inner oblique
middle circular –> forms the pyloric sphincter
outers longitudinal
the aurbach plexus runs in between these two layers
where do we find the most G cells
pylorus
where do we find the deepest gastric pits
pylorus
where do we find the most parietal and chief cells
pylorus
what secretes pepsin
chief cell
what secretes HCl
parietal cell
where in the gland are parietal cells located
upper segment of gastric gland and near the neck
where in the gland do we find chief cells
predominate in lower 1/3 of the gland
where do we find the most peyer’s patches
ileum
where do we find brunner’s glands?
only in duodenum
M cells are generally found where?
overlying the lymphoid tissue of the gut (GALT)
what is the function of the paneth cells?
bottom of the crypts, they have prominent eiosinophilic apical granules. defensive function
how can you tell the difference between the enteroendocrine cells and paneth cells
granules subnucularly in the enteroendocrine cells
what do enteroendocrine cells do
secrete local enzymes CCK Gastrin Secretin each one only secretes one enzyme though