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Phase 1 flashcards > GI anatomy > Flashcards

GI anatomy Flashcards

1
Q

organs of the hepatobilary system

A

liver and gallbladder

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2
Q

organs of the urinary system in the abdomen

A

kidneys and ureters

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3
Q

organs of the endocrine system in the abdomen

A

pancreas and adrenal glands

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4
Q

what is the spleen?

A

haematopoetic and lymphoid organ

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5
Q

lining of the abdominal wall

A

parietal peritoneum

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6
Q

boundaries of the abdominal cavity

A

xiphisternum
costal margin
iliac crests
ASIS
pubic tubercles
pubic symphysis

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7
Q

which lines divide the abdomen into 4 quadrants

A

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

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8
Q

name the quadrants

A

RUQ, LUQ, RLQ, LLQ

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9
Q

which lines divide the abdomen into 9 regions?

A

The right and left midclavicular lines, which extend vertically from the midclavicular point to the mid-inguinal point (halfway between the anterior superior iliac spine and the pubic symphysis)
The subcostal line - horizontal line drawn through the inferior most parts of the right and left costal margins (through 10th costal cartilage)
The intertubercular line (transtubercular) - a horizontal line drawn through the tubercles of the right and left iliac crests and the body of L5

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10
Q

what is the midinguinal point?

A

halfway between ASIS and pubic symphysis

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11
Q

what is the subcostal line?

A

horizontal line drawn through the inferior most parts of the right and left costal margins (through 10th costal cartilage)

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12
Q

what is the intertubecular/ transtubecular line?

A

horizontal line drawn through the tubercles of the right and left iliac crests and the body of L5

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13
Q

what are tubercles?

A

Tubercles - small elevations on a bone
Iliac tubercles are not the same as pubic tubercles
Iliac tubercles - small elevations found in the iliac crest of the iliac bone

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14
Q

transpyloric plane

A

Horizontal line passing through the tips of the right and left ninth costal cartilage
Halfway between the suprasternal notch and the pubic symphysis
Halfway between the umbilicus and the xiphisternum
Transects the pylorus of the stomach, fundus of gallbladder, pancreas, duodenojejunal flexure and hila of kidneys
L1, level of 9th costal cartilages

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15
Q

transumbilical plane

A

Unreliable as position varies depending on the amount of subcutaneous fat present
Lies at L3 in a slender individual

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16
Q

intercristal plane

A

Horizontal line drawn between the highest points of the right and left iliac crests
Cannot be palpated from the anterior aspect of the abdominal wall
Used to guide procedures on the back e.g lumbar puncture and epidural

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17
Q

McBurney’s point

A

The surface marking of the base of the appendix
Lies two thirds of the way along a line drawn from the umbilicus to the right anterior superior iliac spine
Guide for the location of the caecum

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18
Q

identify the nine regions of the abdomen

A

top right to left - right hypochondriac/ epigastric/ left hypochondriac (‘below chondriac’ = below costal cartilages)
middle right to left - right lumbar/ umbilical/ left lumbar
bottom right to left - right iliac region/ suprapubic or hypogastric/ left iliac region

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19
Q

muscles of the anterolateral abdominal wall

A

rectus abdominis
external oblique
internal oblique
transversus abdominis

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20
Q

line in the middle of rectus abdominis

A

linea alba

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21
Q

attachments of rectus abdominis

A

sternum, costal margin, pubis

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22
Q

what surrounds rectus abdominis?

A

aponeurotic rectus sheath

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23
Q

structure of rectus abdominis

A

muscle segments interspersed with horizontal tendinous bands
muscles orientated straight down

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24
Q

orientation of external oblique muscle

A

inferiorly and medially - down and towards the midline

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25
Q

orientation of internal oblique muscle

A

superiorly and medially

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26
Q

orientation of transverses abdominis

A

horizontally

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27
Q

is rectus abdominis paired?

A

yes

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28
Q

describe how the rectus sheath is formed

A

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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29
Q

what lies deep to transversus abdominis?

A

The transversalis fascia lies deep to transversus abdominis
Deep to the fascia lies the parietal peritoneum

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30
Q

what does the rectus sheath contain?

A

Rectus abdominis
Superior and inferior epigastric arteries
Superior and inferior epigastric veins
Nerves
Lymphatics

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31
Q

how is the inguinal ligament formed?

A

most inferior part of external oblique aponeurosis is attached to the:
Anterior superior iliac spine laterally
Pubic tubercle medially
to form the inguinal ligament

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32
Q

where is the inguinal canal?

A

The inguinal canal is just above the inguinal ligament

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33
Q

which arteries supply the anterior abdominal wall?

A

Internal thoracic artery - branch of the subclavian artery
Supplies the anterior chest
Abdominal wall
Breasts
Musculophrenic artery - branch of the internal thoracic
Superior epigastric artery - continuation of the internal thoracic artery. Descends in the rectus sheath
Inferior epigastric artery - branch of the external iliac artery. Ascends in the rectus sheath and anastomoses with the superior epigastric

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34
Q

innervation of the muscles and skin of the anterior abdominal wall

A

Thoraco-abdominal nerves T7-T11(Continuation of the intercostal nerves T7-T11)
- These somatic nerves contain sensory and motor fibres
Subcostal nerve
- Originates from T12 spinal nerve
Name is because it runs along the inferior border of the 12th rib
Iliohypogastric and ilioinguinal nerves
- Branches of the L1 spinal nerve
Dermatomes of the abdominal wall T7-L1

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35
Q

hernias

A

Abnormal protrusion of tissues or organs from one region into another through an opening or defect
Herniae of the anterior abdominal wall may occur if the muscles are weak or have been incised during surgery
A segment of the small intestine may protrude through a defect in the wall, forming a visible and palpable lump under the skin

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36
Q

laparotomy

A

Surgical opening of the anterior abdominal wall undertaken for major operations where good access to the abdomen is needed
A midline sagittal incision of the linea alba involves minimal risk to nerves and muscles
Ideally, muscles are split rather than cut
Where possible, laparoscopy (keyhole surgery) is performed, as it is associated with less post-operative pain, faster wound healing and a smaller risk of wound infection and post-operative hernia

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37
Q

what is an AAA?

A

Abdominal aortic aneurysm (AAA/ triple A)
An abnormal swelling in the aortic wall
Affected portion becomes distended, weak and prone to rupture
Detected as a pulsatile mass on an abdominal examination

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38
Q

organs deep to the right upper quadrant

A

liver, gallbladder, duodenum, right kidney,
ascending colon, hepatic flexure and transverse colon

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39
Q

organs deep to the right lower quadrant

A

ileum, caecum, appendix, ascending colon

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40
Q

organs deep to the left upper quadrant

A

liver (left lobe), stomach, jejunum, spleen, left
kidney, transverse colon, splenic flexure, descending colon

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41
Q

organs deep to the left lower quadrant

A

descending colon, sigmoid colon

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42
Q

organs deep to the epigastrium

A

liver, pancreas, stomach, transverse colon

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43
Q

organs deep to the umbilical region

A

small intestine, transverse colon

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44
Q

organs deep to the suprapubic region

A

small intestine, sigmoid colon, rectum, bladder

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45
Q

organs deep to the right hypochondrium

A

liver, gallbladder, ascending and transverse
colon

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46
Q

organs deep to the left hypochondrium

A

stomach, spleen, tail of the pancreas, transverse
and descending colon

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47
Q

organs deep to the right lumbar region

A

small intestine, ascending colon

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48
Q

organs deep to the left lumbar region

A

small intestine, descending colon

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49
Q

organs deep to the right iliac fossa

A

small intestine, caecum, appendix, right ovary and
right uterine tube in females

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50
Q

organs deep to the left iliac fossa

A

descending and sigmoid colon, left ovary and left
uterine tube in females

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51
Q

describe the anatomy of a six pack

A

The right and left rectus abdominis muscles lie either side of the linea alba.
* Rectus abdominis is comprised of muscle segments (typically three)
interspersed with horizontal tendinous bands.
* When the muscle segments hypertrophy with exercise, they bulge either side
of the tendinous bands and can been seen on the anterior abdominal wall as bulges – the ‘six-pack’

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52
Q

are intra or retroperitoneal organs mobile?

A

intraperitoneal

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53
Q

which peritoneum can be seen?

A

parietal, not visceral

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54
Q

innervation of the parietal peritoneum

A

Receives the same somatic nerve supply as the region of the abdominal wall that it lines
Innervated by the somatic nerves that supply the overlying muscles and skin of the abdominal wall

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55
Q

how does injury to the parietal peritoneum present?

A

Pain is sharp, severe and well localised to the abdominal wall

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56
Q

how does injury to the parietal peritoneum present?

A

Pain is sharp, severe and well localised to the abdominal wall

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57
Q

can visceral peritoneum be seen?

A

no

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58
Q

innervation of visceral peritoneum

A

visceral sensory nerves which 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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59
Q

how does injury to visceral peritoneum present?

A

Pain can be severe, but usually dull and diffuse (cannot be pinpointed to a specific location)
Painful sensations may be perceived as nausea or distension

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60
Q

what is the peritoneal cavity?

A

Potential space between the parietal and visceral peritoneum
Thin film of peritoneal fluid lies in the cavity, allowing the viscera to slide freely alongside each other
Peritoneal fluid consists of water, electrolytes, leukocytes and antibodies

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61
Q

what does intraperitoneal mean?

A

almost completely covered by the peritoneum suspended in the peritoneal cavity

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62
Q

name intraperitoneal organs

A

Sigmoid colon
Appendix
Liver
Transverse colon
Stomach
Small intestine
(SALTSS)

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63
Q

what does retroperitoneal mean?

A

posterior to the peritoneum, hence only covered by peritoneum on their anterior surface

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64
Q

name retroperitoneal organs

A

Duodenum
Ascending colon
Descending colon
Pancreas
Oesophagus
Kidneys
(DADPOK)

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65
Q

what does secondarily retroperitoneal mean?

A

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

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66
Q

features of mesenteries, omenta, ligaments and folds

A

All composed of peritoneum
Connect organs to each other and the abdominal wall
May carry blood vessels, nerves and lymphatics to the viscera
Contain a variable amount of fat - omenta is usually very fatty

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67
Q

what is a mesentery?

A

Folds of peritoneum that contain fat and suspend the small intestine and parts of the large intestine from the posterior abdominal wall
Arteries that supply the intestine from the posterior abdominal wall (from abdominal aorta) and veins that drain the gut (tributaries of the portal venous system) are embedded in the mesenteries

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68
Q

what is the greater omentum?

A

hangs from the greater curvature of the stomach and lies superficial to the small intestine
usually very fatty

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69
Q

what is the lesser omentum?

A

connects the stomach and duodenum to the liver. hepatic artery, hepatic portal vein and bile duct (portal triad) are embedded within its free edge
extends from the liver and attaches to the lesser curvature of the stomach and the first part of the duodenum
usually very fatty

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70
Q

what organ do the omenta connect to?

A

stomach

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71
Q

what are ligaments?

A

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

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72
Q

what is the falciform ligament?

A

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

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73
Q

what are the coronary and triangular ligaments?

A

Coronary and triangular ligaments - connect the superior surface of the liver to the diaphragm

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74
Q

what are peritoneal folds?

A

Raised from the 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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75
Q

what does the median umbilical fold represent?

A

Represents the remnant of the urachus, an embryological structure that connected the bladder to the umbilicus

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76
Q

where does the median umbilical fold lie?

A

in the midline

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77
Q

what do the medial umbilical folds represent?

A

Represent the remnants of the paired umbilical arteries, which returned venous blood to the placenta in foetal life

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78
Q

where do the medial umbilical folds lie?

A

Lateral to the median umbilical fold

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79
Q

what do the medial umbilical folds represent?

A

remnants of the paired umbilical arteries, which returned venous blood to the placenta in foetal life

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80
Q

what do the lateral umbilical folds overlie?

A

inferior epigastric arteries which supply the anterior abdominal wall

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81
Q

what sections is the peritoneal cavity divided into?

A

lesser and greater sac

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82
Q

what is another name for the omental bursa?

A

lesser sac

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83
Q

where does the lesser sac lie?

A

posterior to the stomach and anterior to the pancreas
posterior to the stomach and lesser omentum

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84
Q

what connects the lesser and greater sac?

A

epiploic foramen/ omental foramen

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85
Q

where does the epiploic foramen lie?

A

posterior to the free edge of the lesser omentum

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86
Q

embryology of the viscera

A

The viscera do not develop in the locations we see them in an adult
The gastrointestinal system develops from the embryonic gut tube
Lies in the midline of the abdominal cavity
Suspended from the posterior abdominal wall by the dorsal mesentery
Major branches of the abdominal aorta that supply the developing gut tube travel through the dorsal mesentery
The ventral mesentery connects the stomach to the anterior abdominal wall
As the liver grows within it, the anterior part of the ventral mesentery becomes the falciform ligament and the posterior part becomes the lesser omentum
During development, organs grow, migrate and rotate towards their final positions
As they do so, they pull their peritoneal attachments with them
Growth, migration, and rotation of organs during development is responsible for the formation of the lesser sac and results in some organs being pushed onto the posterior abdominal wall and becoming retroperitoneal
The umbilical vein is the embryological structure that forms the ligamentum teres

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87
Q

what does the GI system develop from?

A

embryonic gut tube

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88
Q

what suspends the embryonic gut tube from the posterior abdominal wall?

A

dorsal mesentery

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89
Q

which embryological structure forms the ligamentum teres?

A

umbilical vein
carries oxygenated blood from the placenta to the foetus
the veins enters the liver
after birth, the umbilical vein closes, the remnant is the ligaments teres

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90
Q

what is peritonitis?

A

Inflection and inflammation of the peritoneum
May be localised (to the region of peritoneum adjacent to the inflamed organ)
Or generalised (affecting the whole peritoneum)
Caused by inflammation of an organ or rupture of a hollow viscus
Rupture of the intestine allows faecal matter and bacteria to contaminate the peritoneum
As the peritoneum has a large surface area and is semi-permeable, peritonitis can lead to sepsis and is hence a life-threatening condition
Extremely painful

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91
Q

what are peritoneal adhesions?

A

Pathological fibrous connections between the parietal and visceral peritoneum
Irritation e.g by infection, causes peritoneum to produce fibrin which adheres the parietal and visceral peritoneum
Cause chronic abdominal pain
Increase the risk of volvulus (twisting) of the intestine, as it can no longer move freely

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92
Q

what is ascites?

A

An increased volume of peritoneal fluid
Occurs secondary to other pathology, such as heart failure, liver failure or intra-abdominal malignancy
Abdomen is distended and uncomfortable
Ascitic drain removes the fluid and relieves symptoms, but fluid reaccumulates

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93
Q

why would a surgeon want to avoid cutting lateral umbilical folds?

A

overlie inferior epigastric vessels, which bleed profusely if cut

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94
Q

what is peritoneal dialysis?

A

Peritoneal dialysis is a form of dialysis for patients who have end-stage renal failure. It is an alternative to haemodialysis.
* A tube is inserted into the abdomen (which remains permanent) and dialysis
solution is introduced.
* The solution draws waste products and excess fluid across the peritoneum
and into the fluid over several hours. The fluid is then drained out and discarded.

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95
Q

at which level is the oesophageal hiatus?

A

T10

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96
Q

what passes through the oesophageal hiatus?

A

oesophagus
vagus neves
inferior oesophageal arteries and veins

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97
Q

what artery supplies the oesophagus?

A

branches from the left gastric arteries

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98
Q

venous drainage of the 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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99
Q

what is the left border of the stomach?

A

greater curvature

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100
Q

what is the right border of the stomach?

A

lesser curvature

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101
Q

folds on the internal aspect of the stomach

A

rugae

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102
Q

sphincters of the stomach

A

inferior oesophageal sphincter
pyloric sphincter

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103
Q

name the parts of the stomach

A

cardia
fundus
body
antrum
pyloric antrum
pyloric canal

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104
Q

most superior part of the stomach

A

fundus

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105
Q

largest part of the stomach

A

body

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106
Q

which part of the stomach contains the pyloric sphincter?

A

pyloric canal

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107
Q

name structures lying posteriorly to the stomach

A

pancreas
diaphragm
splenic artery and vein

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108
Q

where does the lesser sac lie?

A

posterior to the stomach and lesser omentum

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109
Q

which quadrant does the stomach lie in?

A

left upper quadrant

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110
Q

which surface of the stomach is related to the anterior abdominal wall, diaphragm and left lobe of liver?

A

anterior

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111
Q

what does the posterior surface of the stomach form?

A

anterior wall of lesser sac

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112
Q

name structures forming the posterior wall of the lesser sac

A

pancreas
left kidney
spleen

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113
Q

which structures does the lesser omentum connect?

A

lesser curvature of the stomach and liver

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114
Q

name structures contained within the free edge of the lesser omentum

A

hepatic artery, hepatic portal vein, bile duct - portal triad

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115
Q

what is posterior to the free edge of the the lesser omentum?

A

entrance to the lesser sac

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116
Q

at which level does the coeliac trunk leave the abdominal aorta?

A

T12

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117
Q

name the branches of the coeliac trunk

A

left gastric
splenic artery
common hepatic artery

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118
Q

blood supply of the foregut

A

coeliac trunk

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119
Q

blood supply of the midgut

A

superior mesenteric artery

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120
Q

blood supply of the hindgut

A

inferior mesenteric artery

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121
Q

organs of the foregut

A

stomach
first half of duodenum
liver
gallbladder
pancreas
spleen - technically not a foregut structure (develops in the dorsal mesentery and is mesodermal in origin) but derives its blood supply from the coeliac trunk

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122
Q

blood supply of the lesser curvature

A

left and right gastric arteries
anastomose

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123
Q

where does the left gastric artery arise from?

A

coeliac trunk directly

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124
Q

where does the right gastric artery arise from?

A

common hepatic artery

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125
Q

blood supply of the greater curvature of the stomach

A

left and right gastro-omental (gastroepiploic) arteries
anastomose

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126
Q

where does the left gastro-omental arise from?

A

splenic artery

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127
Q

where does the right gastro-omental arise from?

A

gastroduodenal
which is a branch of the common hepatic

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128
Q

what do the short gastrics supply?

A

greater curvature

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129
Q

venous drainage of the stomach

A

left and right gastric veins and right and left gastro-omental veins
which drain into the hepatic portal vein

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130
Q

which blood vessel carries nutrient rich venous blood from the GI tract to the liver?

A

HPV

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131
Q

parasympathetic innervation of the stomach

A

vagus

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132
Q

effect of parasympathetic stimulation of the stomach?

A

peristalsis
gastric secretion

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133
Q

effect of sympathetic stimulation of the stomach

A

contraction of the sphincters

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134
Q

sympathetic innervation of the stomach

A

greater splanchnic nerve
formed of preganglionic sympathetic fibres from T5-T9
pass through sympathetic trunk without synapsing
the fibres synapse in prevertebral ganglia around the coeliac trunk
postganglionic fibres travel to the stomach and inhibit peristalsis and secretion

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135
Q

hiatus hernia

A

Abdominal oesophagus and upper part of stomach herniate through oesophageal hiatus into thorax
If contents of the stomach reflux into the oesophagus - heartburn, acid reflux

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136
Q

what is a gastric ulcer?

A

Mucosal lining of stomach breaks down
Usually due to infection with Heliobacter pylori which erodes the mucosal lining
Muscular wall exposed to gastric acid and enzymes
Erosion through wall and into blood vessels leads to intra-abdominal bleeding

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137
Q

pyloric stenosis

A

Congenital malformation
Hypertrophy of the circular smooth muscle of the pyloric sphincter
Presents six weeks after birth
Vomiting
Treated surgically

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138
Q

gastric cancer

A

Presents late as symptoms are non specific
Abdominal discomfort, early satiety, loss of appetite, nausea, weight loss, difficulty swallowing, indigestion

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139
Q

which structures lie anterior to the stomach?

A

left lobe of the liver
anterior abdominal wall

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140
Q

what lies posterior to the stomach?

A

The lesser sac.
Posterior to the lesser sac lies the pancreas and diaphragm.

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141
Q

function of the small intestine

A

digestion and absorption of food

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142
Q

folds of mucosa inside small intestine

A

plicae circulares

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143
Q

name the parts of the small intestine, proximal to distal

A

duodenum, jejunum, ileum

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144
Q

what is the duodenum curved around?

A

head of pancreas

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145
Q

is the duodenum intraperitoneal or retroperitoneal?

A

mostly retroperitoneal

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146
Q

what is the major duodenal papilla?

A

opening of the bile duct and main pancreatic duct into the duodenum

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147
Q

embryological origin of the first and second half of the duodenum?

A

first - foregut
second - midgut

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148
Q

when does the duodenum become jejunum?

A

when a mesentery begins to develop

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149
Q

artery of the foregut

A

coeliac trunk

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150
Q

artery of the midgut

A

superior mesenteric artery

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151
Q

are the jejunum and ileum retroperitoneal or intraperitoneal?

A

intraperitoneal

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152
Q

what suspends the jejunum and ileum from the posterior abdominal wall?

A

mesentery of the small intestine

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153
Q

blood supply of the jejunum and ileum

A

superior mesenteric artery
(artery of the midgut)

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154
Q

adaptations of the small intestine for nutrient absorption

A

villi and microvilli
plicae circulares
long and coiled
vast surface area

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155
Q

internal differences between jejunum and ileum

A

plicae circulares more pronounced in jejunum
internal ileum contains Peyer’s patches

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156
Q

what are Peyer’s patches?

A

large submucosal lymph nodes of the internal ileum

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157
Q

what is Meckel’s diverticulum?

A

Blind-ended diverticulum approximately one metre from the ileum’s termination
Embryological remnant of the connection that was present between the midgut loop to the yolk sac
Mimics appendicitis when inflamed

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158
Q

which abdominal region does the terminal ileum become the caecum?
what is this called?

A

right iliac fossa
ileocaecal junction

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159
Q

where does blood from the jejunum and ileum drain?

A

superior mesenteric vein

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160
Q

which veins combine to form the hepatic portal vein to the liver?

A

splenic and superior mesenteric vein

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161
Q

what are haustrations?

A

sacculations produced from where the teniae coli contract to shorten the wall of the bowel

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162
Q

what are tenia coli?

A

3 strips of longitudinally running muscle on the outer surface of the large intestine

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163
Q

what are appendices epiploicae?

A

Small pouches of fat filled peritoneum
Mark where blood vessels enter the bowel to supply the mucosa

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164
Q

function of the large intestine

A

Water absorption from faecal material to form semi-solid faeces

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165
Q

name the components of the large intestine in order

A

Caecum
Appendix
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Anal canal

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166
Q

which parts of the large intestine are intraperitoneal?

A

Caecum, transverse colon and sigmoid colon are intraperitoneal

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167
Q

describe the structure of the large intestine?

A

Outer longitudinal muscle layer organised into three bands - taeniae coli
Inner circular muscle layer forms bulges called haustra (haustrations)
Bears fatty tags called epiploic appendages that mark the point at which blood vessels penetrate the intestinal wall

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168
Q

what is the first part of the large intestine?

A

caecum

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169
Q

where does the appendix arise from?

A

caecum

170
Q

what connects the appendix and caecum?

A

mesoappendix

171
Q

on which side of the posterior abdominal wall does the ascending colon run?
what is this place called?

A

right
right paracolic gutter

172
Q

where is the hepatic flexure (right colic flexure), and what is it?

A

right upper quadrant
the 90 degree turn in the ascending colon where it becomes the transverse colon
named so because it bends under the liver

173
Q

what connects the transverse colon to the posterior abdominal wall?

A

transverse mesocolon

174
Q

where is the splenic flexure (left colic) and what is it?

A

left upper quadrant
the 90 degree turn in the transverse colon where it becomes the descending colon
named because of location relative to the spleen

175
Q

what connects the splenic flexure and diaphragm?

A

phreniocolic ligament

176
Q

which part of the large intestine marks the transition point between the embryological midgut and hindgut?

A

transverse colon

177
Q

where does the midgut end?

A

after the proximal two thirds of the transverse colon

178
Q

where does the hindgut start?

A

distal third of the transverse colon

179
Q

where does the descending colon run?

A

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

180
Q

where does the sigmoid colon run?

A

left lower quadrant

181
Q

what mesentery does the sigmoid colon lie in?

A

sigmoid mesocolon

182
Q

what is the bend in the sigmoid colon called?

A

rectosigmoid junction

183
Q

which three large arteries supply the GI tract, and where do they originate?

A

coeliac trunk
superior mesenteric artery
inferior mesenteric artery

abdominal aorta

184
Q

what does the coeliac trunk supply?

A

foregut
oesophagus, stomach, first half of duodenum, liver, gallbladder, bile ducts, pancreas, spleen

185
Q

where does the superior mesenteric artery leave the abdominal aorta?

A

L1

186
Q

what does the superior mesenteric artery supply?

A

midgut
second half of duodenum, small intestine, large intestine as far as first two thirds of transverse colon
branches also supply part of the pancreas

187
Q

what does the inferior mesenteric artery supply?

A

hindgut
distal third of transverse colon, descending ind sigmoid colon, rectum, upper third of anal canal

188
Q

where does the inferior mesenteric artery leave the abdominal aorta?

A

L3

189
Q

name some branches of the SMA

A

jejunal branches - supply jejunum
ileal branches - supply ileum
ileocolic artery - supplies caecum, appendix, ascending colon
right colic artery - supplies ascending colon
middle colic artery - supplies the transverse colon

190
Q

describe the blood supply of the small intestine

A

jejunal and ileal branches are embedded in the mesentery of the small intestine
they anastomose with each other, forming loops of arteries called arcades
from these arcades run the vasa recta (straight vessels) which supply the intestinal walls

191
Q

name branches of the inferior mesenteric artery

A

left colic artery - supplies transverse colon and descending colon
sigmoid branches supply the sigmoid colon
superior rectal artery - terminal branch of the IMA, supplies the upper rectum

192
Q

what is the marginal artery?

A

Branches of the middle colic artery (from the SMA) and the left colic artery anastamose along the distal third of the transverse colon and the splenic flexure forming the marginal artery

193
Q

blood supply of the lower rectum

A

blood vessels originating from the internal iliac arteries in the pelvis

194
Q

venous drainage of the hindgut

A

inferior mesenteric vein
which accompanies IMA
drains into the splenic vein

195
Q

where does the IMV ascend?

A

left side of the abdomen

196
Q

what vessels form the hepatic portal vein?

A

superior mesenteric vein and splenic vein

197
Q

origin of hepatic veins, and can they be seen externally?

A

after nutrients have been removed, blood enters small hepatic veins which unite within the liver - cannot be seen externally

198
Q

parasympathetic innervation of the foregut and midgut

A

vagus

199
Q

parasympathetic innervation of the hindgut

A

pelvic splanchnic nerves

200
Q

where do the cell bodies of preganglionic parasympathetic neurone lie?

A

S2-S4
The axons of these neurons leave the spinal cord and form the pelvic splanchnic nerves

201
Q

where are parasympathetic ganglia located?

A

very close to or within the walls of the viscera

202
Q

sympathetic innervation of the abdominal viscera

A

greater lesser and least splanchnic nerves

203
Q

which splanchnic nerve innervates the foregut? which spinal segments is this?

A

greater
T5-T9

204
Q

which splanchnic nerve innervates the midgut?
which spinal segments is this?

A

lesser
T10-T11

205
Q

which splanchnic nerve innervates the hindgut?
which spinal segments is this?

A

least
T12

206
Q

describe the dermatomes of the abdominal region, and referred pain

A

Segments T5-T9 receive information from dermatomes T5-T9 - upper abdomen and epigastrium
Segments T10-T11 receive information from dermatomes T10-T11 - umbilical region
Segment T12 receives information from dermatome T12 - suprapubic region
Pain from abdominal viscera is referred to the body wall
Epigastric pain - foregut pathology
Central abdomen/ umbilical - midgut pathology
Lower abdomen/ suprapubic - hindgut

207
Q

appendicitis

A

Inflammation of the appendix
Pain begins in the umbilical region and is poorly localised
Result of irritation of the visceral peritoneum
Visceral sensory afferents returning to spinal cord segment T10
As inflammation progresses, the adjacent parietal peritoneum becomes involved
Causes severe, well localised pain in the right iliac fossa (which is conveyed to the CNS via somatic nerves that innervate the body wall)
History is of diffuse umbilical pain that ‘moves’ to the right iliac fossa
Symptoms vary depending on where the appendix lies
Maximal tenderness over McBurney’s point
Rupture of the appendix leads to peritonitis
Appendectomy usually performed via laparoscopy

208
Q

mesenteric ischaemia

A

Mesenteric arteries occluded by a thrombus
Results in ischaemia of the intestine which may progress to infarction
Acute mesenteric ischaemia is a surgical emergency
Gut must be revascularised and necrotic intestine removed
High mortality, even when the condition is recognised and treated

209
Q

IBD

A

Crohn’s disease and ulcerative colitis are two types of IBD
Flare ups of both can be serious and lead to life-threatening conditions
Affected parts of the gut may be removed if medication does not work
Crohn’s
Inflammation of the gut mucosa
Affects any part of the GI tract but typically affects the small intestine
Abdominal pain, diarrhoea, bloody stools, weight loss and tiredness
Ulcerative colitis
Affects the colon and rectum
Mucosa becomes inflamed and ulcerated
Abdominal pain, bloody diarrhoea, weight loss, tiredness

210
Q

colon cancer

A

Bowel cancer
Change in bowel habits, bloody stools, abdominal pain, bloating
Colonoscopy allows visualisation of the colon and biopsies can be taken if a mass is seen

211
Q

volvulus

A

Twisting of the gut
Affects mobile parts of the gut (i.e have a mesentery)
Most common at the sigmoid colon
Twisting obstructs the passage of faeces
May cause ischaemia and infarction of the affected part of the gut

212
Q

venous drainage of the spleen

A

splenic vein

213
Q

Which veins drain blood from the large intestine and where does it flow to?

A

The superior mesenteric vein drains the midgut part of the large intestine (as
far as 2/3 of the way along the transverse colon). The superior mesenteric vein unites with the splenic vein to form the hepatic portal vein, which enters the liver
The inferior mesenteric vein drains the hindgut part of the large intestine. The inferior mesenteric vein joins the splenic vein.

214
Q

What four anatomical features ensure the small bowel has a high surface area for absorption of nutrients?

A

It is very long
* The mucosa is folded (plicae circulares)
* The mucosal folds bear villi and there are microvilli on the luminal surface of each epithelial cell.
* These features ensure that the jejunum and ileum, which are the sites of nutrient absorption, have a vast surface area

215
Q

Where is the ‘junction’ between the midgut and the hindgut?

A

Approximately 2/3 of the way along the transverse colon. The proximal 2/3 are
derived from the midgut and the distal 1/3 is derived from the hindgut.

216
Q

How might you distinguish a loop of large intestine from that of small intestine?

A

Large intestine is peripherally located; small intestine is centrally located
* The large intestine is of greater calibre (i.e. it has a wider lumen)
* The large intestine has epiploic appendages, haustrations and taeniae coli.

217
Q

What do the following terms mean: colectomy, colostomy, ileostomy

A

A colectomy is removal of part of the colon (-ectomy means removal, e.g.
appendicectomy [removal of the appendix], mastectomy [removal of the
breast]).
* Colostomy is an operation in which, after part of the colon is removed, the
remaining, last part of the colon is connected to an opening (stoma) created in the anterior abdominal wall. The colon empties into a bag placed over the stoma.
* If the whole colon is removed, the terminal ileum is connected to a stoma created in the anterior abdominal wall. This procedure is called an ileostomy.

218
Q

where does the liver lie?

A

right upper quadrant

219
Q

where is bile produced?

A

liver

220
Q

where is bile stored?

A

gallbladder

221
Q

function of bile

A

emulsify lipids in the chyme entering the duodenum from the stomach

222
Q

name the two surfaces of the liver?

A

diaphragmatic - anterosuperior, related to the inferior surface of the diaphragm
visceral - posteroinferior, related to other organs

223
Q

where is the liver not covered by visceral peritoneum?

A

bare area - lies in contact with the diaphragm
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 (hilum of the liver)

224
Q

what is the bare area of the liver?

A

where the liver lies in contact with the diaphragm

225
Q

what separates the two anatomical lobes of the liver?

A

falciform ligament

226
Q

how many lobes does the liver have?

A

two

227
Q

which lobe of the liver is larger?

A

right

228
Q

function of the falciform ligament

A

connect the anterior surface of the liver to the internal aspect of the anterior abdominal wall

229
Q

name the two accessory lobes of the liver, and their relative positions

A

caudate and quadrate
caudate is superior to quadrate

230
Q

On which surface are the accessory lobes of the liver located?

A

posteroinferior surface of the liver

231
Q

how many functional segments of the liver are there?

A

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

232
Q

do the lobes of the liver represent the internal, functional organisation of the liver?

A

no

233
Q

name the three components of the portal triad
where are portal triads found?

A

bile duct
hepatic artery
hepatic portal vein

corners of the lobules

234
Q

what does the common hepatic artery give rise to?

A

gastroduodenal artery

235
Q

what is the common hepatic called after it gives off the gastroduodenal?

A

hepatic artery proper

236
Q

what does the hepatic artery proper bifurcate into?

A

right and left hepatic arteries

237
Q

venous drainage of the liver

A

two or three large hepatic veins

238
Q

fate of the hepatic veins

A

unite with the inferior vena cava as it passes posterior to the liver

239
Q

innervation of the liver

A

hepatic plexus

240
Q

what forms the hepatic plexus?

A

parasympathetic fibres from the vagus nerves and sympathetic fibres

241
Q

where is liver pathology referred?

A

epigastrium

242
Q

what connects the liver to the diaphragm?

A

coronary and triangular ligamants

243
Q

what connects the liver to the stomach and duodenum?

A

lesser omentum

244
Q

where does the portal triad run?

A

free edge of lesser omentum

245
Q

what forms the anterior boundary of the epiploic foramen?

A

portal triad and free edge of lesser omentum

246
Q

what is the hepatorenal recess?

A

Lies between the right kidney and the posterior (visceral) surface of the right side of the liver
Fluid flows into this space in the supine position

247
Q

what are the left and right subphrenic recesses?

A

Lie either side of the falciform ligament
Between the anterosuperior surface of the liver and the diaphragm

248
Q

what part of the gut is the liver?

A

foregut

249
Q

development of the liver

A

Develops from the embryological foregut
Grows from a tissue bud that develops in the ventral mesentery - peritoneal fold in the upper abdomen that connects the stomach to the anterior abdominal wall
Liver grows and migrates to the right side of the abdomen
Its peritoneal attachments are pulled with it
Remains of the ventral mesentery form the lesser omentum and the falciform ligament
Peritoneal attachments of the liver anchor it to surrounding structures, including the diaphragm superior to it

250
Q

embryological remnants in the liver

A

Round ligament of the liver (ligamentum teres)
Contained in the free edge of the falciform ligament
Remnant of the umbilical vein - carries oxygenated blood from the placenta to the foetus
Ligamentum venosum
Lies on the posterior surface of the liver
Lies in the groove between the caudate lobe and the left lobe of the liver
Remains of the ductus venosus - diverts blood from the umbilical vein to the IVC in a foetus. Shunts oxygen rich blood to the heart and bypassing the liver

251
Q

draw, label and describe the billary tree

A

Bile is continuously produced by hepatocytes
Excreted into bile canaliculi
Canaliculi drain into bile ducts of increasing calibre
Bile ducts converge to form right and left hepatic ducts that exit the liver at the porta hepatis
Left and right hepatic ducts converge to form the common hepatic duct
Common hepatic duct receives the cystic duct from the gallbladder
Distal to this point, the duct is called the (common) bile duct
The bile duct 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
Bile duct enters the duodenum
Bile enters the gallbladder for storage via the cystic duct
The spiral fold (spiral valve) lies at the junction between the gallbladder neck and the cystic duct

252
Q

name the parts of the gallbladder

A

fundus, body, neck

253
Q

Function of the gallbladder

A

stores and concentrates bile

254
Q

on which surface of the liver is the gallbladder?

A

posteroinferior (visceral)

255
Q

what is the main part of the gallbladder?

A

body

256
Q

in which fossa does the gallbladder sit on the visceral surface of the liver?

A

gallbladder fossa

257
Q

which part of the gallbladder communicates with the cyctic duct?

A

neck

258
Q

what is the rounded end of the gallbladder?

A

fundus

259
Q

surface marking of the fundus of the gallbladder

A

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

260
Q

arterial supply of the gallbladder

A

cystic artery

261
Q

venous drainage of the gallbladder

A

cystic veins

262
Q

innervation of the gallbladder

A

visceral afferents

263
Q

where is visceral gallbladder pain referred to? where else may gallbladder pain be referred to, and why?

A

epigastrium, spinal cord levels T5-T9

skin over the shoulder, if it irritates the diaphragm
diaphragm is innervated by phrenic nerve C3-5, which also receives somatic sensory information from the skin over the shoulder

if gallbladder pathology irritates the parietal peritoneum which is innervated by somatic nerves, pain is well localised to the right hypochondrium

264
Q

hepatomegaly

A

Liver enlargement
Causes
-Hepatitis (liver inflammation from various causes)
-Malignancy
-Heart failure
Inferior border becomes palpable inferior to the right costal margin

265
Q

liver metastases

A

As venous blood from the gut passes through the liver, bowel cancers often metastasise to the liver
Primary cancer of the liver can occur but is less common

266
Q

liver cirrhosis

A

Scarring of the liver
Caused by
-Chronic excess alcohol consumption
-Chronic infection with hepatitis B or C
-Build up of fat in the liver
Hepatocytes are destroyed and replaced with fibrous tissue
Liver becomes shrunken, hard and nodular
Loss of hepatocytes impairs the function of the liver and liver failure may ultimately result

267
Q

portal hypertension

A

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

268
Q

oesophageal varices

A

Portosystemic anastomoses are 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 the portal system (via the gastric veins)
If flow in the portal system is obstructed, pressure in the portal system increases and blood is diverted from the portal veins into the systemic veins
Systemic veins become distended and varicose - called oesophageal varices in the oesophagus
Rupture of these vessels leads to catastrophic bleeding

269
Q

Gallstones, biliary colic and cholecystitis

A

Gallstones are mostly composed of cholesterol
Often asymptomatic
Cause symptoms when they migrate into the biliary tree
A gallstone lodges in the cystic duct causes pain when the gallbladder contracts - biliary colic
If the stone moves back into the gallbladder, the pain eases
If iit does not, the stone blocks the flow of bile into the cystic duct and the gallbladder becomes inflamed - cholecystitis
Cholecystectomy
Removal of the gallbladder
Usually performed laparoscopically

270
Q

which artery gives rise to the cystic artery?

A

right hepatic artery

271
Q

which structures are found in the porta hepatis?

A

Macroscopically – the hepatic portal vein, the right and left hepatic arteries,
the right and left hepatic ducts.
* Microscopically – lymphatics, branches of the vagus nerve and branches of the
greater splanchnic nerve.

272
Q

What structure degenerates to form the ligamentum venosum?

A

The ductus venosus.
* In foetal life, the ductus venosus shunts most of the oxygenated blood in the
umbilical vein directly to the IVC. Only a small amount of blood enters the
developing liver.
* After birth, the ductus venosus closes and its remnant forms the ligamentum
venosum

273
Q

With the patient in a supine position, where might fluid collect in the abdomen?

A

In the hepatorenal recess, which lies between the right kidney and the
posterior (visceral) surface of the right side of the liver.

274
Q

What is the surface marking of the fundus of the gallbladder?

A

The tip of the right ninth costal cartilage.
* Where the right midclavicular line crosses the costal margin.
* At the point of the most lateral attachment of the rectus abdominis onto the
right costal margin.

275
Q

Which nerves may relay pain from diseases of the gallbladder? For each nerve involved, where would the patient feel the pain?

A

Patients may experience gallbladder pain in the epigastrium (involves visceral
sensory (afferent) nerves), right hypochondrium (involves somatic nerves). or
the right shoulder (involves the phrenic nerve).
* The gallbladder is innervated by parasympathetic and sympathetic fibres.
* Visceral afferents from the gallbladder return to the CNS with the sympathetic fibres. Visceral pain from the gallbladder enters spinal cord levels T5 – T9 and is therefore referred to (i.e. felt in) the epigastrium.
* Gallbladder pain may be referred to the right shoulder if gallbladder pathology (e.g. inflammation) irritates the diaphragm. The diaphragm is innervated by the phrenic nerve (C3-5). Spinal cord segments C3-5 also receive somatic sensory information from the skin over the shoulder. Therefore gallbladder pathology involving the diaphragm may be felt in the right shoulder.
* If gallbladder pathology irritates the parietal peritoneum, which is innervated by somatic nerves, pain is well localised to the right hypochondrium

276
Q

Where do the hepatic veins drain to?

A

Directly into the inferior vena cava

277
Q

where does the coeliac trunk leave the anterior aspect of the aorta?

A

T12

278
Q

what does the left gastric artery supply?

A

lesser curvature of the stomach
distal oesophagus

279
Q

what does the common hepatic artery supply?

A

liver, stomach and duodenum

280
Q

what does the splenic artery supply?

A

stomach, pancreas and spleen

281
Q

what is the shortest part of the small intestine?

A

duodenum

282
Q

is the duodenum mainly intraperitoneal or retroperitoneal?

A

retroperitoneal

283
Q

describe the parts of the duodenum

A

superior, (first)
descending
inferior
ascending

284
Q

name structures posterior to the first part of the duodenum

A

bile duct, gastroduodenal artery, hepatic portal vein

285
Q

name the place where the jejunum meets the duodenum

A

duodenojejunal flexure

286
Q

where is the major duodenal papilla?

A

halfway along the internal wall of the duodenum

287
Q

what is the major duodenal papilla?

A

small elevation
marks where bile and digestive secretions (pancreatic juice) enter the duodenum

288
Q

what is the embryological origin of the first half of the duodenum?

A

foregut

289
Q

what is the embryological origin of the second half of the duodenum?

A

midgut

290
Q

blood supply of the duodenum (2 parts)

A

gastroduodenal artery from the common hepatic artery
inferior pancreaticoduodenal arteries from the superior mesenteric artery

291
Q

what do veins from the duodenum drain into?

A

hepatic portal vein

292
Q

at which level does the pancreas lie?

A

Lies horizontally on the posterior abdominal wall at the level of L1

293
Q

is the pancreas intra or retroperitoneal?

A

retroperitoneal

294
Q

appearance of the pancreas?

A

bumpy

295
Q

formation of the pancreas

A

Forms from dorsal and ventral pancreatic buds which fuse during development

296
Q

name the parts of the pancreas

A

Head
Neck
Body
Tail

297
Q

what is the hook-like projection of the head of the pancreas?

A

ucinate process

298
Q

what forms part of the posterior wall of the lesser sac?

A

pancreas

299
Q

which artery runs towards the spleen embedded in the upper border of the pancreas?

A

splenic artery

300
Q

which vein lies posterior to the pancreas?

A

splenic vein

301
Q

functions of the pancreas

A

Endocrine and exocrine function
Synthesises and secretes insulin and glucagon
Produces pancreatic juice that contains digestive enzymes

302
Q

how does pancreatic juice reach the duodenum?

A

Pancreatic juice is transported through main pancreatic duct and accessory pancreatic duct to the duodenum

303
Q

do the main and accessory pancreatic ducts communicate?

A

yes

304
Q

where do the bile duct and main pancreatic ducts merge?

A

hepatopancreatic ampulla

305
Q

where does the hepatopancreatic ampulla open?

A

second part of the duodenum at the major duodenal papilla

306
Q

what surrounds the hepatopancreatic ampulla?

A

smooth muscle
sphincter of Oddi

307
Q

function of the sphincter of Oddi

A

contracts to prevent reflux of duodenal contents into the bile and main pancreatic ducts

308
Q

where does the accessory pancreatic duct empty pancreatic juice into the duodenum?

A

minor duodenal papilla

309
Q

where does the minor duodenal papilla lie?

A

just proximal to the major duodenal papilla

310
Q

blood supply of the pancreas

A

vessels derived from the coeliac trunk and superior mesenteric artery

311
Q

which artery runs along the upper border of the pancreas and gives rise to pancreatic arteries?

A

splenic artery

312
Q

which artery gives rise to the superior pancreaticoduodenal artery?

A

gastroduodenal

313
Q

which artery gives rise to the inferior pancreaticoduodenal artery?

A

superior mesenteric artery

314
Q

which vein drains the pancreas?

A

splenic

315
Q

which veins form the hepatic portal vein?

A

superior mesenteric vein
splenic vein

316
Q

where is the hepatic portal vein formed?

A

posterior to the neck of the pancreas

317
Q

what is the spleen?

A

haematopoetic and lymphoid organ

318
Q

in which quadrant does the spleen lie?

A

left upper quadrant, protected by ribs 9-11

319
Q

functions of the spleen?

A

breakdown of old erythrocytes
storage of erythrocytes and platelets
immune response e.g production of IgG

320
Q

how many surfaces and borders does the spleen have?

A

2 surfaces - diaphragmatic and visceral
4 borders - anterior, superior (notched), posterior, inferior (smooth)

321
Q

is the spleen palpable below the costal margin

A

shouldn’t be

322
Q

arterial supply of the spleen

A

splenic artery from coeliac trunk

323
Q

how many branches does the splenic artery divide into at the hilum?

A

5

324
Q

where does the splenic artery run?

A

superior border of the pancreas, embedded within it

325
Q

venous drainage of the spleen, and where does this vessel run?

A

splenic vein, which runs posterior to the pancreas

326
Q

duodenal ulcer

A

common in the first part of the duodenum
may erode the duodenal wall and gastroduodenal artery which lies posterior to the first part of the duodenum

327
Q

pancreatitis

A

chronic or acute
acute - emergency
causes can be excess alcohol intake or impaction of a gallstone at the hepatopancreatic ampulla
gallstone pancreatitis - impaction of the gallstone prevents pancreatic juice from leaving the pancreas, and it starts to break down the pancreas

328
Q

pancreatic cancer

A

causes pain that radiates to the back
when it affects the head of the pancreas, it can obstruct flow of bile in the bile duct
leads to an accumulation of bile pigments in the blood resulting in jaundice

329
Q

diabetes mellitus

A

insulin producing cells no longer produce enough insulin
sustained high blood glucose levels
can be developed secondary to pancreatitis

330
Q

splenomegaly

A

enlarged spleen
caused by infection, malignancy and portal hypertension
spleen enlarges towards the midline in the direction of the right iliac fossa as the phreniocolic ligament prevents its direct descent towards the left iliac fossa

331
Q

splenic rupture

A

spleen is soft and highly vascular so is vulnerable to blunt abdominal trauma or rib fractures
removal of the spleen - splenectomy
spleen is not essential for life but patients may be more prone to bacterial infections

332
Q

what structures might a tumour of the head of the pancreas involve?

A

hepatic portal vein, bile duct, pancreatic duct

333
Q

what structures join to form the bile duct, and what is its course?

A

The bile duct is formed by the union of the common hepatic duct and cystic
duct.
* The bile duct runs in the free edge of the lesser omentum and behind the first
part of the duodenum. It courses posterior to the head of the pancreas.
* It unites with the main pancreatic duct at the hepatopancreatic ampulla, which
opens into the duodenum at the major duodenal papilla.

334
Q

where is the sphincter of Oddi?

A

It surrounds the hepatopancreatic ampulla. It is located in the medial wall of
the second part of the duodenum, where the hepatopancreatic ampulla opens into the duodenum at the major duodenal papilla.

335
Q

which artery lies behind the first part of the duodenum?

A

gastroduodenal artery

336
Q

what lies between the pancreas and stomach?

A

lesser sac

337
Q

what forms the first part of the respiratory tract?

A

left and right nasal cavities

338
Q

where is the spheno-ethmoidal recess?

A

superoposterior to the superior conchae
between the superior concha and cribriform plate

339
Q

where are olfactory receptors found, and what do they form?

A

mucosa in the upper part of the nasal cavity
spheno-ethmoidal recess

axons form the olfactory nerves (CN I)

340
Q

what separates the left and right nasal cavities?

A

thin midline septum, formed of cartilage and bone

341
Q

what separates the nasal cavities and the oral cavity?

A

hard palate

342
Q

what part of the pharynx does the nasal cavity communicate with posteriorly?

A

nasopharynx

343
Q

what are paranasal sinuses?

A

cavities within the skull bones

344
Q

what is the midline nasal septum formed of anteriorly and posteriorly?

A

cartilage anteriorly
two thin plates of bone posteriorly

345
Q

which bone forms the superior part of the posterior septum?

A

perpendicular plate of the ethmoid bone

346
Q

which bone forms the inferior part of the posterior septum?

A

vomer

347
Q

projections of bone on the lateral wall of the nasal cavity

A

superior, middle and inferior conchae, or turbinates

348
Q

what are the meatuses?

A

spaces INFERIOR to the conchae
in this way, the superior meatus lies inferior to the superior conchae

349
Q

function of the meatuses?

A

warms, humidifies and filters air

350
Q

what separates the nasal cavity and the cranium?

A

cribriform plate

351
Q

what is the cribriform plate?

A

delicate section of bone that is perforated with tiny holes
separates nasal cavity and cranium

352
Q

function of the cribriform plates

A

allow axons of olfactory neurones to pass through the perforations and form the olfactory nerves which travel to the brain

353
Q

where is the spheno-ethmoidal recess?

A

superoposterior to the superior conchae
between the superior concha and cribriform plate

354
Q

what are the paranasal sinuses?

A

cavities within skull bones

355
Q

how are the paranasal sinuses named?

A

according to the bones within they are located

356
Q

where is the frontal sinus?

A

anterior part of the frontal bone

357
Q

where is the ethmoid sinus/ ethmoid air cells?

A

ethmoid bone
superior to nasal cavity and medial to orbits

358
Q

where is the sphenoid sinus?

A

sphenoid bone

359
Q

where is the maxillary sinus?

A

within the maxillae of the facial skeleton
lateral to the lateral walls of the nasal cavity

360
Q

which sinuses are usually clearly seen in the bisected head?

A

frontal and sphenoid

361
Q

where does the frontal sinus drain into?

A

middle meatus

362
Q

where does the sphenoid sinus drain into?

A

spheno-ethmoidal recess

363
Q

where do the ethmoid air cells drain into

A

superior and middle meatuses

364
Q

where does the maxillary sinus drain into?

A

middle meatus

365
Q

why can’t the maxillary sinus drain freely when the head is upright?

A

opening of the maxillary sinus lies superomedially

366
Q

where does the nasolacrimal duct drain into?

A

inferior meatus

367
Q

what does the nasolacrimal duct drain?

A

tears that lubricate the anterior surface of the eye

368
Q

why do we get a runny nose when we cry?

A

excess fluid runs down the nasolacrimal duct, which drains into the inferior meatus

369
Q

in which bone is the middle ear?

A

temporal bone

370
Q

how many bones comprise the middle ear?

A

three

371
Q

what connects the middle ear to the nasopharynx?

A

auditory tube (Eustachian tube)

372
Q

where is the opening of the auditory tube, and how can it be identfied?

A

lateral wall of the nasopharynx
surrounded by a slight bulge which is formed of tonsillar tissue

373
Q

function of the auditory (Eustachian) tube

A

connects the middle ear to the nasopharynx
allows air to pass into the middle ear so that the pressure on either side of the tympanic membrane (eardrum) is equal for optimal conduction of sound waves

374
Q

where does the tympanic membrane lie?

A

between the middle and external ear

375
Q

name an artery supplying the nasal cavity

A

branches of the maxillary artery

376
Q

what is the maxillary artery a terminal branch of?

A

external carotid artery

377
Q

medical name for nosebleed

A

epistaxis

378
Q

innervation of the nose

A

trigeminal nerve (CN V)

379
Q

anterior and posterior composition of the palate

A

anterior hard palate - bone
posterior soft palate - muscle

380
Q

what forms the roof of the oral cavity?

A

the palate

381
Q

which bones form the hard palate?

A

palatine bone of the maxilla
horizontal plate of the palatine bone

382
Q

which bones form the hard palate?

A

palatine bone of the maxilla
horizontal plate of the palatine bone

383
Q

why is the hard palate important?

A

prevents food or fluid entering the nasal cavity
we push our tongue up against the hard palate during the first phase of swallowing, which forces food and fluid backwards into the oropharynx
we push our tongue up against the hard palate to articulate certain sounds

384
Q

cleft palate

A

bones of the hard palate do not develop properly or do not fuse in the midline
cleft remains that allows communication between the nasal and oral cavities
surgically repaired

385
Q

what hangs from the posterior border of the soft palate?

A

uvula

386
Q

what do the muscles of the soft palate do during swallowing?

A

contract to elevate the soft palate
the nasopharynx is closed off from the oral cavity, preventing reflux of food and fluid into the nasal cavity

387
Q

innervation of the muscles of the soft palate

A

vagus

388
Q

which muscles are in the cheeks?

A

buccinator

389
Q

what is the oral cavity continuous with posteriorly?

A

oropharynx

390
Q

how many teeth do adults have?

A

32

391
Q

how many incisors, canines, premolars and molars are there in the upper/ lower jaw?

A

4 incisors
2 canines
4 premolars
6 molars

4,2,4,6

392
Q

composition of the teeth

A

inner pulp containing blood vessels and nerves
dentin surrounding the pulp
outer enamel coating

393
Q

what does the tongue bear on its superior surface?

A

papillae

394
Q

where does the root of the tongue extend into?

A

oropharynx

395
Q

what is the space between the posterior tongue and anterior aspect of the epiglottis?

A

vallecula

396
Q

two types of muscles comprising the tongue

A

intrinsic and extrinsic

397
Q

difference between intrinsic and extrinsic muscles

A

intrinsic muscles
- lie entirely within the tongue
- paired bilaterally and fuse in the midline
- they change the shape of the tongue

extrinsic muscles
- attached to the tongue but originate from outside it (from the mandible and hyoid bone)
- move the tongue

398
Q

innervation of tongue muscles

A

hypoglossal

399
Q

sensory innervation of the tongue

A

taste in the anterior two thirds - facial nerve
general sensation (touch, pain, temperature) in the anterior two thirds - trigeminal nerve
taste and general sensation in the posterior third - glossopharyngeal

400
Q

which arteries supply the oral cavity, and which artery are these a branch of?

A

lingual, maxillary, facial
branches of external carotid

401
Q

innervation of soft palate muscles

A

vagus

402
Q

how many cranial nerves innervate the tongue?

A

four

403
Q

which cranial nerves innervate the tongue and how?

A

hypoglossal
- innervation of the muscles of the tongue

facial
- taste to anterior two thirds

trigeminal
- general sensation to anterior two thirds

glossopharyngeal
- taste and general sensation to posterior third

404
Q

name 4 tonsils

A

pharyngeal tonsils (adenoid)
tubal tonsils
palantine tonsils
lingual tonsils

405
Q

which tonsils lie in the roof and posterior wall of the nasopharynx?

A

pharyngeal (adenoid)

406
Q

where is the adenoid/ pharyngeal tonsil?

A

roof and posterior wall of the nasopharynx

407
Q

where is the tubal tonsil?

A

surrounds the opening of the auditory tube on the lateral wall of the nasopharynx

408
Q

where is the palatine tonsil?

A

lateral wall of the oropharynx
usually referred to as ‘the tonsils’, as they are visible on either side of the oropharynx when the mouth is open

409
Q

where is the lingual tonsil?

A

in the posterior tongue

410
Q

name places in the body where lymphoid tissue can be found

A

spleen, tonsils, lymph nodes, Peyer’s patches

411
Q

what is lymphoid tissue?

A

support the immune response

412
Q

treatment of epistaxis

A

applying pressure
cauterising the bleeding vessels
nasal tampon

413
Q

which bone is vulnerable in nose fractures?

A

cribriform plate of ethmoid bone

414
Q

sinusitis
which sinus is most problematic when affected by sinusitis and why?

A

inflammation or infection of the mucosa lining the paranasal sinuses
maxillary
- do not drain freely unless lying down on one side
- inflammation of the maxillary sinus may cause cheek pain as the sensory nerve that supplies the cheek runs in the roof of the maxillary sinus

415
Q

which is the only contralateral cranial nerve?

A

trochlear
only cranial nerve where clinical findings are on the other side

416
Q

which is the only cranial nerve to have a dorsal exit from the brainstem?

A

trochlear

417
Q

symptoms of hypoglossal nerve palsy

A

injury to the left or right hypoglossal nerve results in:
atrophy and weakness of the ipsilateral tongue muscles
tongue deviates to the injured side when the patient protrudes their tongue

418
Q

presentation of mouth cancer?

A

ulcers, lumps, patches of discolouration on the oral mucosa

419
Q

tonsilitis and tonsillectomy

A

tonsillitis - inflammation of the tonsils
usually affects palatine tonsils
can be caused by a viral or bacterial infection
tonsils become enlarged, red and may be covered in pus appearing as white spots in the surface of the tonsils
painful swallowing
inflammation and enlargement of the pharyngeal tonsil (adenoid) is common in children
enlargement may obstruct nearby opening of the auditory tube, resulting in fluid accumulation in the middle ear and hearing impairment
recurrent infection of the tonsils may be managed by tonsillectomy - surgical removal of the tonsils

420
Q

function of the auditory tube

A

equalise air pressure on either side of the tympanic membrane
important for optimal movement of the typanic membrane

421
Q

why would an infant with a cleft palate have difficulty feeding?

A

Cleft palate allows reflux of liquid and food into the nasal cavity.
* The palate also plays an important role in swallowing as the first part of
swallowing involves pressing the tongue up against the hard palate to force
food backwards.
* For infants that are breast or bottle feeding, sucking also involves the tongue
being pressed up against the palate – this is obviously impaired (or even impossible) if there is a gap in the palate.

422
Q

why may poor oral hygiene lead to a dental abcess?

A

Poor hygiene (ineffective or insufficient brushing) allows bacteria and
foodstuffs to erode the outer enamel layer of the tooth.
Decay and infection of the inner pulp may follow and can lead to infection of
the bone.

Phase 1 flashcards (27 decks)

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