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IMED3112 > GI Anatomy > Flashcards

GI Anatomy Flashcards

1
Q

Nerve supply to body wall at which three spinal levels?

A

T7 at xiphoid process
T10 at umbilicus
L1 at lowest point (pubic symphysis)

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2
Q

Abdominal cavity boundaries - superior, posterior, inferior and anterior?

A

Superior - diaphragm muscle (rib 5 when relaxed)
Posterior - vertebral bodies, ribs, iliac fossa, muscles (diapgragm crurae, iliopsoas, quad lumborum, transverse abdominis
Inferior - continuous with pelvic cavity but around pelvic diaphragm
Anterior - external (V), internal (A), transverse (-)

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3
Q

What is an aponeurosis and what is its role?

A

sheet-like tendon with attachment points of all three muscle layers forming the rectus sheath.
Role is to stop movement and create pressure

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4
Q

Function of abdominal wall(3)?

A

1.containment, protection, strength
2.respiration and voice projection
3.posture, stability, movement

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5
Q

Rectus sheath layers and edge/partition?

A

Anterior/superficial - aponeurosis of extrenal obliques
Posterior/deep - transverse abdominis and internal obliques
lateral edge - linea semilunaris
middline - linea alba

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6
Q

Role of arcuate line?

A

Above umbilicus - deep layer passes posteriorly to rectus abdominus
Below umbilicus - all layers pass anteriorly to rectus abdominus meaning wall is weaker

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7
Q

8 layers of abdominal wall?

A

1.Skin
2.Fascia - campers (fatty) then Scarpas (membranous)
3. External oblique (aponeurosis)
4.Internal Oblique (muscle)
5.Transversalis Abdominus
6.Transversalis fascia
7. Extraperitoneal fat
8.Peritoneum

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8
Q

Importance of Scarpas fascia?

A

Attaches to inguinal ligament and linea alba meaning ther eis no connection to lower limb. BUT, it is continuous with peritoneum ans space insode scrotum (Colles fascia) meaning bleed in abdominal wall can spread into peritoneum and swell there

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9
Q

Contents of male and female inguinal canal?

A

Male - spermatic cord
Female - Round ligament of uterus (reminant of gubernaculum)

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10
Q

Spermatic cord and scrotum layers (8 relating to body wall)?

A
  1. Scrotal skin and datros muscle
  2. Colles fascia (continuous with scarpas)
  3. external spermatic fascia
  4. Cremaster muscle
  5. NOTHING (trans abdominus doesnt travel down cord)
  6. Internal spermatic fascia
  7. Loose CT and fat/testis
  8. processus/tunica vaginalis
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11
Q

What governs the descent of the testis and gives it space to move in scrotum?

A

Gubernaculum draws testis through labio/scrotal folds and doesnt change size.
Processus vaginalis is continuous with abdominal cavity but closes off during development giving testis ability to move inside scrotum

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12
Q

What is a hernia?
Places, causes, consequences?

A

-When an organ is pushed through a hole in a body wall.
-Intra-abdominal pressure forces contents through
-Inguinal, femoral, umbilical, oesophageal
-Due to congenital, parturition, increasing pressure (heavy weight lifting

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13
Q

Indirect vs Direct hernia?

A

Indirect - Congenital, through both deep and superficial ring as processus vaginalis wasnt closed off so herniated through spermatic cord
Direct - Acquired due to weakened abdominal muscles. Herniates through superficial ring only and not inside spermatic cord

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14
Q

What does food travel through and around?

A

Travels through piriform recess and around/closing epiglottis to larynx

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15
Q

What muscle controls pitch of the vocal cord?

A

Cricothyroid

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16
Q

What are the 3 constrictor muscles and their origin and insertion points?

A
  1. Superior constrictor - from pterygomandibular raphe to midline raphe
  2. Middle constrictor - from greater and lesser horns of hyoid bone to midline raphe
  3. Inferior constrictor - from thyroid and cricoid to midline raphe
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17
Q

What is at the end of the pharynx?

A

Cricopharyngeus

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18
Q

What are the 3 longitudinal pharyngeal muscles and where do they come from?

A
  1. Stylopharyngeus - From styloid process so must enter between superior and middle constrictors
  2. Palatopharyngeus - from soft palate
  3. Salpingopharyngeus - from auditory tube
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19
Q

What are the 3 phases of deglutition and muscles involved?

A
  1. Oral - voluntary chewing including tongue gathering bolus to pharynx, soft palate contracting to close nasopharynx, mylohyoid contracting to raise tongue o help push food back, palatoglossus contracts to close off oropharynx
  2. Pharyngeal - Reflex (fraction of a second) GVA CN.IX sensory, SVE CN.X motor for longitudinal muscles to raise larynx to fold epiglottis. Stylopharyngeus (from CN.IX and X) widens pharynx and pulls pharynx up and over food then constricting to pull it back down (fast skeletal action)
  3. Oesophageal - Involuntary with smooth muscle peristalsis taking over around 1/3
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20
Q

Where do the nerves and arteries enter the pharynx?

A

Between middle/inferior - Internal laryngeal nerve and superior artery
Below inferior - recurrent laryngeal nerve and inferior artery

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21
Q

What is the structure of endodermal tubes?

A
  1. Lumen
  2. Mucosa - epithelium, lamina propria, muscularis mucosa
  3. Submucsa - loose Ct with blood vessels, nerves and glands
  4. Muscularis externa - inner circular, outer longitudinal
  5. Adventitia (anchored) or serosa (free serous membrane)
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22
Q

Oesophagus: role, muscle action, epithelium

A

1.Role - transport of rough and dry foods
2.Muscle action - skeletal in upper 1/3 to move food quickly, sm in distal for peristaltic wave contraction and energy efficiency
3. Stratified squamous epithelium for protection and not absorption

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23
Q

Stomach: storage, control, digestion, protection?

A

Storage - 0.2-4L, rugae allowing for expansion
Cardiac sphincter structural preventing reflux
Pyloric sphincter physiological releasing aliquots of chyme into duodenum
Digestion mechanical and enzymatic
Mucous lining from secretory cheath protects from own acids and acids and enzymes protect from pathogens by killing them (pH 1.5-3)

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24
Q

Cells of the fundus?

A

Chief - produce pepsinogen which breaks down protein
Parietal - produce HCl
G-Cells - secrete gastrin which stimulated parietal cells and converts pepsinogen t pepsin form chief cells
D-cells - produces somatostatin which inhibits EVERYTHING

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25
Q

Duodenum: epithelium, role submucosal glands?

A

Simple columnar with microvilli and very few goblet cells.
Chemical digestion by billiary secretions entering via duodenal papilla
Submucosal glands protect against digesting ourselves by secreting alkaline mucous (only really seen in duodenum)

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26
Q

Jejunum vs ileum; epithelium, control of sm, role?

A

Jejunum - many plicae circularis and large villi with short crypts for absorption
Ileum - fewer PC, small villi with deep crypts for secretion
Smooth muscle with parasympathetic action controlled by myenteric nerve plexus for peristalsis

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27
Q

2 specific features of ileum and not jejunum and their role?

A

Protection
1.Peyers patches in ileum containing lymph nodules, B and T cells to protect from pathogens. Paneth cells secrete lysozymes to regulate bacterial environment
2. Goblet cells - more in ileum and more secretion needed to protect against abrasion

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28
Q

Large intestine: Intra/retro peritoneal components and role?

A

Caecum - IP
asc colon - RP
transverse colon - IP
desc colon - RP
sigmoid - IP
rectum - RP
Role - reabsorb digestive products and water, dries faeces (need goblet cells), slows propulsion (haustra), defecation (triggered by rectal distension)

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29
Q

Structure of veriform appendix?

A

Similar to colon but no haustra, thick muscularis externa with lymphoid nodules

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30
Q

Anorectal junction: epithelium, what seperates the two sphincters?

A

simple columnar to stratified columnar to stratified squamous.
Hilton white line separates two sphincters

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31
Q

Dorsal components of tongue: papillae (4), nerves (2,1), foramen caecum

A

Papillae - filiform, fungiform, circumvallate, foliate
Anterior 2/3 - taste from facial CN.VII, somatic afferent from lingual CN.V3
Posterior 1/3 - taste CN.IX, contains foramen caecum in midline which was origin for thyroid

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32
Q

Muscles of the tongue: intrinsic (3), extrinsic (4), nerve supply?

A

Intrinsic - vertical, transverse, longitudinal (CN.IIX) tongue shape
Extrinsic - genioglossus, hyoglossus, styloglossus (CN.IIX) and palatoglossus (CN.X - pharynx) tongue position

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33
Q

Muscles of mouth floor (2)?

A
  1. Mylohyoid forms floor of mouth, CN.V3, origins from mandible
  2. Digastric
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34
Q

Linguinal papillae epithelium and role (4)?

A
  1. Filiform - keratinised stratified squamous creating rough surface to aid manipulating food
  2. Fungiform - nonkeratinised with some tatse buds
  3. Circumvallate - largest, 8-10 along terminal sulcus, tatse buds and excretory ducts of serous glands
  4. Foliate - appear as folds along dorsolateral tongue with taste buds and excretory duct openings
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35
Q

Salivary glands: (3) location, nerves?

A

1.Parotid - next to ear outside oral cavity. Lesser petrosal nerve (CN.IX) ganglion in otic then auriculotemporal nerve (CN.V3)
2. Sublingual - same as below
3.Submandibular - Chorda tympani (CN.VII) ganglion in submandibular then lingual nerve (CN.V3)

36
Q

Ducts (2)?

A
  1. Intralobular - intercalated ( from acinus to larger duct with cuboidal epithelium), striated (forming the duct with columnar with mitochondria on basal side and nuclei on apical side)
  2. Interlobular - larger excretory ducts with more surrounding CT
37
Q

Secretory acini (2)?

A
  1. Serous - watery product from round nuclei on cell basal side. Cytoplasm pink with amylase enzyme granules. Mainly in parotid gland as watery product less likely to get stuck in duct coming from far away
  2. Mucinous - Viscous product from flattened nuclei with secretory vesicle filling much of cytoplasm. Sublingual gland
  3. Submandibular is mixed with external part being more serous and internal more viscous.
38
Q

Foregut, midgut, hindgut: location, artery, nerve supply, vein?

A

Foregut - oesophagus to 1/2 duodenum, coeliac artery, coeliac ganglion, splenic and gastric veins
Midgut - 1/2 duodenum to 2/3 transverse colon, superior mesenteric artery, ganglion, vein
Hindgut - 2/3 transverse duodenum to anus,inferior mesenteric artery, ganglion, vein

39
Q

What is mesentery and peritoneum?

A

Mesentery is peritoneal reflections wrapping around an organ. Peritoneum is a mesothelial lining with visceral covering organ and parietal covering body wall.

40
Q

Intraperitoneal, primary retroperitoneal, secondary retroperitoneal and examples?

A
  1. Intraperitoneal - Organs have mesentery, all derived from gut tube (unpaired aortic artery A and drain into portal system) eg. transverse colon, sigmoid colon
  2. Primary retroperitoneal - behind mesentery so never had mesentery and not derived from gut tube (paired aortic artery B and drain into caval system) eg. kidney
  3. Secondary retroperitoneal - behind mesentery but had mesentery and then lost it through zygosis (combining of peritoneal linings by adhesions) all derived from gut tube so vascular patterns still apply. eg pancreas
41
Q

Foregut appendages: ventral (3) and dorsal (2)?

A

Ventral mesogastrium - liver, gallbaldder, ventral pancreas
Dorsal mesogastrium - dorsal pancreas, spleen

42
Q

What is the hepatic diverticulum appendages, function and development?

A

Ventral pancreas, hepato-pancreatic duct, gallbaldder, common bile duct, hepatic duct. Function is to creat bile ducts and hepatic cells. Initiation of liver gene expression inhibits gallbaldder and pancreatic growth (ventral pancreas smaller than dorsal)

43
Q

What is the quadrangular and triangular fusion?

A

Small intestine re-entry pushed descending colon against body wall on left side, and zygosis sticks desc. colon to dorsal body wall creating quadrangular fusion. Caecum and ascending colon pushed to the right against posterior body wall creating triangular fusion.

44
Q

What is the only entry into the lesser sac?

A

Epiploic foramen

45
Q

What is the cloacal membrane? Developmental errors (3)?

A

covered in surface ectoderm, it divides urinary and genital systems from digestive (urogenital from anorectal) but it can have fistulas or developmental errors (volvulus, omphalocele, meckels diverticulum)

46
Q

What does the pectinate line divide? Blood and nerve supply above and below it?

A

Pectinate line is where endoderm is in contact with ectoderm and separates rectum from anus.
Rectum
-Superior rectal artery from inferior mesenteric
-middle rectal artery from internal iliac (coming from inferior mesenteric)
-inferior rectal artery from pudendal (coming from internal iliac)(systemic drainage)
-visceral nerve supply
Anus
-somatic nerve supple

47
Q

Foregut: Coeliac arteries? Anastomoses?

A

1.1 Left gastric
1.2 Accessory hepatic
1.3 Oesophageal
2.1 Splenic
2.2 Short gastric
2.3 Left gastro-epiploic
3.1 Commom hepatic
3.2 Gastroduodenal - R gastroepiploic, supraduodenal, superior pancreaticoduodenal
3.3 Right gastric
3.4 Hepatic propper - L hepatic, R hepatic, cystic
Anastomoses
-Left and Right gastric
-Left and right gastro-epiploic
-Superior pancreaticoduodenal (and inferior PD from superior mesenteric artery)

48
Q

Midgut: Superior mesenteric arteries?

A
  1. Inferior pancreaticoduodenal
  2. Jejunal branches
  3. Ileal branches
  4. Ileocolic
  5. Right colic
  6. Middle colic
49
Q

Hindgut: Inferior mesenteric arteries? Marginal artery?

A
  1. Left Colic - superior and inferior branches
  2. Sigmoid
  3. Superior rectal

Marginal Artery - anastomosis/collection of all arteries around colon

50
Q

What is the portal system and what is the function of it?

A

Passage of capillary beds passing through the liver before the heart. Function is for high nutrient blood to go through first pass metabolism and reabsorb nutrients back into liver before the heart.

51
Q

What are porto-caval anastomoses and where are the found?

A

Portal to caval circulation bypass for the blood if portal resistance is too high.
1. Caudal oesophagus via azygous vein
2. Recto-anal junction via middle and inferior rectal veins to internal iliac vein
3. Para-umbilical veins around lig teres via epigastric veins (Caput Medusae if pressure in liver too high, blood empties backwards)
4. Bare areas drain to retroperitoneal organs via veins on body wall ie. top of liver, kidney

52
Q

Gut parasympathetic nervous supply? (2 nerves)

A
  1. Vagus - to thoracic, forgut and midgut organs entering adbomen on either side of oesophagus
  2. Pelvic splanchnic nerves (S234) supply hindgut and pelvic organs
53
Q

Gut sympathetic nervous supply? (5 nerves) and fore/mid/hindgut supply?

A

Thoracic splanchnic
1. Greater T5-9
2. Lesser T19-11
3. Least T12
4. Lumbar splanchnic L1-2, L3g-5g
5. Sacral splanchnic S1g-5g

Foregut - Greater
Midgut - greater and LESSER
hindgut - Least, lumbar, sacral

54
Q

What is visceral referred pain and what area does it come from/relate to?

A

Referred to dermatomes where sympathetic nerves are derived from
1. Foregut - T5-9 - epigastric
2. Midgut - T9-11 - Umbilical (T10)
3. Hindgut T11-L1 - hypogastric

55
Q

What is phrenic referred pain?

A

Somatic referred pain from C3-5 which is irritation from organs in direct contact with diaphragm eg, heart, liver, gallbladder with pain being felt over dermatome (shoulder and arm)

56
Q

Anterior and posterior components of the liver?

A

Anterior - where falciform separates and attaches to diaphragm
Posterior - Formation of lesser omentum

57
Q

How many functional segments and lobes and what defines them?

A

Segments - 8 defined by portal triads
Lobes - 2 separated by Principle line tracing middle hepatic vein from gallbaldder fossa to IVC

58
Q

Which direction does blood and bile move?

A

Blood - Triad to CV
bile - CV to triad

59
Q

Classic lobule?

A

Flow to and from a central vein - 6 triads to one CV, mainly concerned with venous drainage

60
Q

Portal Lobule?

A

Flow to and from triad - 3 CV around one triad, mainy concerned with bile drainage

61
Q

3 zones of acinus and effects of blood loss and toxins?

A
  1. Closest to short axis joining two triads - first to see hepatic arterial blood so least affected by blood loss but most affected by toxins
  2. Intermediate transitional zone
  3. Furthest from hepatic arterioles so first to show necrosis due to blood loss but last to be affected by toxins
62
Q

Hepatocyte: role, shape, stellate cells?

A

Fill up 80% of liver and secrete bile. They are large polyhedral cells with large round nuclei. Stellate cells have a role in regeneration, vit A storage and transport

63
Q

What is the perisinusoidal space?

A

Space between hepatocyte and epithelial cells where plasma can freely enter. Macrophages attached to epithelium

64
Q

What is the importance of the liver capsule?

A

Capsule continuous with CT of porta hepatis an contains own blood and lymph supply. It can contain subcapsular hepatic hematomas and bleeding which otherwise would be life threatening if ruptured

65
Q

Where is bile made, stored, released and its role?

A

Made in liver, stored in gallbladder, released into duodenum and emulsifies fats. Reabsorbed back through colon and transported back through portal system

66
Q

What are the 6 billiary system components?

A
  1. major duodenal papilla
  2. Main pancreatic duct
  3. Commom bile duct
  4. Cystic duct
  5. Common hepatic duct
  6. L and R hepatic ducts
67
Q

How does the gallbladder fill/empty and what epithemium?

A

Fills due to vacuum pressure and empties due to smooth muscle contraction via cystic duct to common bile duct. SImple columnar epothelium with microvilli helping with water reabsorption.

68
Q

Pronephros: challenge, adaptation, result? Why do humans not have it?

A

Challenge - body salt higher than water salt therefore pressure for salt to leave and water to get in
Adaptation - create glomerulus which is a bundle of vessels into coelomic space allowing for osmotic control
Result - gets rid of water with water filtered out through pronephric duct to cloaca

In humans, pronephros derived from cervical nephrotomes around day 24, degenerates around day 26 and only needed for due to signalling required ontogenetically for next step

69
Q

Mesonephros: Challenge, adaptation, result?

A

Challenge - body salt less than water salt so pressure for water to leave body
Adaptation - Mesonephros filters with large tubular network
Result - air has less water and salt so we have a tendancy to dry out so tubular network drains into cloaca

70
Q

Human mesonephros appearance and regression?

A

Appears around week 4 derived from thoracic and sacral lumbar nephrotomes and regress cranial to caudal with thoracic segments around week 5, lumbar around week 12. It produces some urine between week 6-12

71
Q

Metanephros: where does it grown from and what does it induce?

A

Metanephric ducts grow from dorsal side of pelvic mesonephric ducts around week 5. Metanephric ducts induce sacral IMM to form metanephric blastema which repeatedly bifurcates

72
Q

Role of metanephric urine?

A

Increases and circulates amniotic fluid volume, not for waste purposes (placenta does that) so healthy amount of amniotic fluid signals a healthy kidney function as fluid goes into gut tube and help with patency

73
Q

When do metanephric kidneys ascend and how to components around it change?

A

Week 6
Urinary metanephric ducts (ureters) extend, arterial and venous components aquire new paired branches as kidney ascends

74
Q

What happens if kidney fails to ascend? (2)

A
  1. Pelvic kidney
  2. Horseshoe kidney where L and R kidneys become attached in pelvis and cannot ascend above inferior mesenteric artery
75
Q

In adult kidney, what are the margins, where does the hilum sit and which kidney is higher/has longer veins?

A

Margins of psoas muscle and quad lumborum. Upper poles sit on diaphragm around ribs 11 and 12 with left kidney higher due to no liver. Hilum around L1/2 with A to P = vein, artery, ureter. Left renal vein longer due to IVC being on right side of the body as left cardinal veins mostly obliterate so left renal vein crosses to right to anastomose via subcardinal anastomoses

76
Q

Where is ureter input and urethra output in bladder?

A

Trigone area with input at top and output at bottom.

77
Q

What is the allantois?

A

Primitive bladder creating the bladder and uracus which is a reminant becoming a ligament at apex of bladder

78
Q

5 segments of kidney artery and nerve supply?

A

renal artery
1. Segmental
2. Interlobar
3. Arucate
4. Radiate
5. Afferent arteriole
Vasomotor control with parasympathetic from vagus to increase GFR and sympathetic from lesser splanchnic T10-11

79
Q

Process of making urine?

A

Filter blood, reabsorb water, salts, glucose, secrete protein.
Passive mechanism of conter current flow between capillaries and tubules creating pressure and osmosis and diffusion

80
Q

Cells of filtration in kidney? (2)

A
  1. Juxtaglomerular cells - modified smooth muscle on afferent and release renin in responce to stretch and macula densa cell stimulation
  2. Macula Densa cells - cells of DCT in contact with glomerulus that are sensitive to Na and Cl and stimulate JGC
81
Q

What are the types of nephrons and what do they do?

A
  1. Cortical Nephrons - short LoH but not as good at reclaiming
  2. Juxtaglomerular nephrons - less common but LoH descends deeper. If macula densa cells detect high Na and Cl (high BP) then signals constriction in JGC to decrease GFR. If Na and Cl too low (low BP), JGC signaled to release renin and increase GFR and BP
82
Q

PCT vs DCT histology

A

PCT - fluffy and bigger but fewer nuclei as there is more mitochondria for active transport. High surface area with lots of microvilli
DCT - smaller but more cells and nuclei but no microvilli so not fluffy. Less active transport so less space so more cuboidal epithelium

83
Q

Ureter epithelium, histology and movement?

A

Transitional epithelium to protect against stretch with stratified squamous near distal urethra to protect from abrasion. Mucosa and muscularis external. Ureter moves urine by peristalsis, urethra moves urine by bladder and abdominal pressure from stretch and detrusor muscle activation

84
Q

Where does ureter cross pelvic brim?

A

at bifurcation of common iliac arteries around L4

85
Q

Blood and nerve supply for upper ureter and lower ureter and bladder?

A

Upper ureter
1. Blood from renal arteries
2. Para from vagus, symp from least T12
Lower ureter and bladder
1. Blood from vesicular arteries
2. Para from pelvis splanchnic S234 via hypogastric plexus to detrusor sm. Symp from sacral splanchnic L1 to tighten sphincter

86
Q

What is the micturition reflex?

A

Stretch sensitive afferent trigger detrusor contraction from pelvic splanchnic to hypogastric plexus to detrusor sm, but can be consciously overridden

87
Q

What stops urine flowing back up ureters?

A

Ureter enters bladder through posterior wall and through muscular component so when detrusor muscle contracts, it acts as a value so not back flow

IMED3112 (17 decks)

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