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Gastrointestinal > GI anatomy - Full summary > Flashcards

GI anatomy - Full summary Flashcards

1
Q

What joint allows opening and closure of the mouth?

A

Temperomandibular joint

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2
Q

What bones are involved in the temperomandibular joint?

A

Temporal bone
Mandible

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3
Q

How many muscles of mastication are there?

A

4

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4
Q

How many muscles open the jaw?

A

1

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5
Q

How many muscles close the jaw?

A

3

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6
Q

Which muscle opens the jaw?

A

Lateral pterygoid muscle

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7
Q

What are the 3 muscles that open the mouth?

A

Masseter
Temporalis
Medial pterygoid

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8
Q

Where can the masseter be palpated?

A

At the corner of the jaw when the jaw is clenched

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9
Q

Where can the temporals be palpated?

A

At the pterion of the skull when the jaw is clenched

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10
Q

Which nerve supplies the muscles of mastication?

A

The mandibular branch of the trigeminal nerve (CN V3)

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11
Q

Describe the structure of the temperomandibular joint

A
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12
Q

What occurs in dislocation of the jaw?

A

The head of the condylar (Posterior) process of the mandible moves out of the mandibular fossa and moves infant of the articular tubercle of the temporal bone and becomes lodged

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13
Q

Where does the oral cavity start?

A

Behind the teeth

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14
Q

What are the 2 forms of palate in the oral cavity?

A

Hard palate - Palatine bones
Soft palate - Soft tissue

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15
Q

What is the uvula?

A

The ending of the soft palate that dangles down into the throat

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16
Q

What are the 2 arches in the oral cavity?

A

Palatoglossal arch - Anterior arch
Palatopharyngeal arch - Posterior arch

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17
Q

Where are the palatine tonsils found?

A

Either side of the oral cavity, posterior to the arches

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18
Q

What is the name given to the space between the teeth and lips?

A

The vestibule

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19
Q

What connects the lips and the gingiva (Gums)?

A

The upper and lower labial frenula

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20
Q

What is the name given to the cheek tissue?

A

Buccal tissue

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21
Q

What is the average number of teeth in an adult human?

A

32

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22
Q

What is the average age by which all teeth, including wisdom teeth, should have erupted?

A

18 (If wisdom teeth don’t erupt by 25, presume that they won’t)

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23
Q

What are the 4 quadrants of the dentition?

A

Upper left
Upper right
Lower left
Lower right

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24
Q

How many teeth are found in the average human quadrant?

A

8

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25
Q

Which numbered teeth in a quadrant are incisors?

A

1 and 2

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26
Q

Which numbered tooth in a quadrant is a canine?

A

3

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27
Q

Which numbered teeth in a quadrant are pre-molars?

A

4 and 5

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28
Q

Which numbered teeth in a quadrant are molars?

A

6, 7 and 8
(8 = Wisdom tooth)

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29
Q

What is the name given to the space behind the wisdom teeth?

A

Retromolar trigone

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30
Q

What are the 3 types of salivary glands?

A

Parotid
Sub-mandibular
Sub-lingual

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31
Q

Where does the parotid gland empty into?

A

The papillae in the upper buccal wall on each side of the vestibule, behind the 2nd upper molars

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32
Q

Where do the submandibular glands empty to?

A

The frenulum of the tongue

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33
Q

Where do the sub-lingual glands empty to?

A

The floor of the mouth

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34
Q

What is the name of cranial nerve I and what type of nerves does it supply?

A

Olfactory - Sensory

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35
Q

What is the name of cranial nerve II and what type of nerves does it supply?

A

Optic - Sensory

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36
Q

What is the name of cranial nerve III and what type of nerves does it supply?

A

Occulomotor - Motor

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37
Q

What is the name of cranial nerve IV and what type of nerves does it supply?

A

Trochlear - Motor

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38
Q

What is the name of cranial nerve V and what type of nerves does it supply?

A

Trigeminal (V1,2 & 3) - Both sensory and motor

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39
Q

What is the name of cranial nerve VI and what type of nerves does it supply?

A

Abducens - Motor

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40
Q

What is the name of cranial nerve VII and what type of nerves does it supply?

A

Facial - Both sensory and motor

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41
Q

What is the name of cranial nerve VIII and what type of nerves does it supply?

A

Vestibulocochlear - Sensory

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42
Q

What is the name of cranial nerve IX and what type of nerves does it supply?

A

Glossopharyngeal - Both sensory and motor

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43
Q

What is the name of cranial nerve X and what type of nerves does it supply?

A

Vagus - Both sensory and motor

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44
Q

What is the name of cranial nerve XI and what type of nerves does it supply?

A

Spinal accessory - Motor

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45
Q

What is the name of cranial nerve XII and what type of nerves does it supply?

A

Hypoglossal - Motor

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46
Q

What are the functions of cranial nerve V3 (Trigeminal 3) in the upper GI tract?

A

Supplies general sensation to lower oral cavity
Gives general sensation to anterior tongue
Gives motor sensations to jaw muscles
Supplies sublingual salivary glands (With chord timpani of VII)

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47
Q

What are the functions of cranial nerve V2 (Trigeminal 2) in the upper GI tract?

A

Gives general sensation to the upper half of the oral cavity
Gives general sensation to middle face

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48
Q

What are the functions of cranial nerve IX (Glossopharyngeal ) in the upper GI tract?

A

Supplies posterior oropharynx with motor and sensory (Gag reflex)
Supplies general and special sensory to posterior tongue
Supplies secretomotor innervation to parotid gland

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49
Q

What are the functions of cranial nerve X (Vagus) in the upper GI tract?

A

Supplies posterior oropharynx with motor nerves (Gag reflex)
Allows contraction of pharynx

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50
Q

What are the functions of cranial nerve VII (Facial) in the upper GI tract?

A

Supplies special sensory (Taste) to anterior tongue
Supplies sub-lingual salivary gland (Chordae timpani branch)

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51
Q

What are the functions of cranial nerve XII (Hypoglossal) in the upper GI tract?

A

Supplies motor innervation to the tongue muscles (Not palatoglossus)

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52
Q

Describe the route of cranial nerve V2 (Trigeminal 2)?

A

From pons
Through foramen rotunda
To mid-face and upper jaw

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53
Q

Describe the route of cranial nerve V3 (Trigeminal 3)?

A

From pons
Through foramen ovale
To muscles of mastication and inferior oral cavity

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54
Q

Describe the route of cranial nerve VII (Facial)?

A

From pontomedullary junction
Through internal acoustic meatus
Branches (to form chordae timpani, which joins V3 to supply sub-lingual glands)
Through stylomastoid foramen
To anterior tongue, facial expression muscles and glands in mouth floor

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55
Q

Describe the route of cranial nerve IX (Glossopharyngeal)?

A

From medulla
Through jugular foramen
To posterior oropharynx, parotid gland and posterior tongue

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56
Q

Describe the route of cranial nerve XII (Hypoglossal)?

A

From medulla
Through hypoglossal canal
To muscles of tongue (Except palatoglossus)

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57
Q

How does the gag reflex occur?

A

Contact with posterior oropharynx stimulates cranial nerve IX (Glossopharyngeal)
This stimulates motor nerves of cranial nerves IX and X (Glossopharyngeal and Vagus)
This elevates the pharynx and larynx, shortening the pharynx and closing the laryngeal inlet

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58
Q

How many muscles cause movement of the tongue?

A

8 pairs of muscles (16 muscles total)

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59
Q

How many pairs of extrinsic muscles control the tongue?

A

4

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60
Q

How many pairs of intrinsic muscles control the tongue?

A

4

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61
Q

What are the 4 pairs of extrinsic muscles that control the tongue?

A

Palatoglossus (Palate to tongue)
Styloglossus (Styloid process to tongue)
Hyoglossus (Hyoid to tongue)
Genioglossus (Genial tubercles of mandible to tongue)

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62
Q

What do the intrinsic muscles of the tongue change?

A

The shape of the tongue

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63
Q

What do the extrinsic muscles of the tongue change?

A

The position of the tongue

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64
Q

What are the 3 layers of circular constrictor muscles of the pharynx?

A

Superior constrictor
Medial constrictor
Inferior constrictor

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65
Q

Why can swallowing only go one way?

A

The circular constrictor muscles contract sequentially and so only contract to push food down

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66
Q

Which cranial nerve innervates the circular muscles of the pharynx?

A

Cranial nerve X (Vagus)

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67
Q

What muscle forms the end of the pharynx and the inlet to the oesophagus?

A

Cricopharyngeus muscle

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68
Q

What is the function of the inner layer of longitudinal muscles in the pharynx?

A

They elevate the pharynx and larynx, shortening the pharynx and closing the laryngeal inlet

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69
Q

Which nerve supplies the inner layer of longitudinal muscles in the pharynx?

A

Cranial nerves X and IX (Vagus and glossopharyngeal)

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70
Q

What happens to the oesophagus when nothing is passing down it?

A

It closes

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71
Q

What type of sphincter is the upper oesophageal sphincter?

A

Anatomical sphincter

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72
Q

What type of sphincter is the lower oesophageal sphincter?

A

Physiological sphincter

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73
Q

What forms the upper oesophageal sphincter?

A

The cricopharyngeus muscle

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74
Q

What causes the formation of the lower oesophageal sphincter?

A

Contraction of the diaphragm
Intra-abdominal pressure being higher than intra-gastric pressure
Oblique angle at which the oesophagus enters the cardia

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75
Q

What are the 3 main constrictions of the oesophagus?

A

Cervical constriction - Cricopharyngeus
Thoracic constriction - Arch of aorta and left main bronchus
Diaphragmatic constriction - Lower oesophageal sphincter

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76
Q

What is the function of the oesophageal nerve plexus that runs along its surface?

A

It innervates the smooth muscle with both types of autonomic supply, allowing for acceleration and deceleration of peristalsis

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77
Q

What is the name given to the top right region of the abdomen?

A

Right hypochondrium

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78
Q

What is the name given to the top left region of the abdomen?

A

Left hypochondrium

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79
Q

What is the name given to the upper middle region of the abdomen?

A

Epigastric region

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80
Q

What is the name given to the middle left region of the abdomen?

A

Left lumbar (Flank)

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81
Q

What is the name given to the middle right region of the abdomen?

A

Right lumbar (Flank)

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82
Q

What is the name given to the central region of the abdomen?

A

Umbilicus

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83
Q

What is the name given to the middle left region of the abdomen?

A

Left lumbar (Flank)

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84
Q

What is the name given to the lower right region of the abdomen?

A

Right iliac fossa (Inguinal)

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85
Q

What is the name given to the lower middle region of the abdomen?

A

Surpapubic (Pubic)

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86
Q

What is the name given to the lower left region of the abdomen?

A

Left iliac fossa (Inguinal)

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87
Q

How can the abdomen be split into 4 regions?

A

Upper left quadrant
Upper right quadrant
Lower left quadrant
Lower right quadrant
These are in the median plane and trans-umbilical plane

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88
Q

What is the name of the anterior muscle of the abdomen?

A

Rectus abdominus

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89
Q

What are the 3 muscles of the anterolateral chest wall?

A

External oblique - Most superficial
Internal oblique
Transversus abdominus - Most deep

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90
Q

What are the semicircular lines formed at the divide between muscle and aponeurosis known as?

A

Linea semilunaris

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91
Q

What is the name of the fascia at the division between muscle and aponeurosis of the abdomen?

A

Spigalean fascia

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92
Q

What is the rectus sheath?

A

The sheath that surrounds the rectus abdominus, formed from the joining of bilateral aponeuroses

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93
Q

What is the name of the line formed down the midline, formed by the joining of bilateral aponeuroses?

A

Linea alba

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94
Q

Which layers of aponeuroses form the posterior wall of the rectus sheath?

A

Transversus abdominus
Posterior half of inner oblique

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95
Q

Which layers of aponeuroses form the anterior wall of the rectus sheath?

A

Outer oblique
Anterior half of inner oblique

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96
Q

Where are some common points of herniation in the abdominal wall?

A

Linea alba
Linea semilunari
Inguinal canal

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97
Q

What is formed as the rectus sheath moves inferiorly?

A

The inguinal ligament

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98
Q

Where does the inguinal ligament attach to the skeleton?

A

At the pubic tubercle

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99
Q

What boundary is marked by the inguinal ligament?

A

The boundary between the thigh and the abdomen

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100
Q

What is found beneath the inguinal ligament?

A

The inguinal space contains many important structures

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101
Q

What is the inguinal canal made up of?

A

The inguinal ligament and body wall

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102
Q

What is the function of the inguinal canal?

A

It allows the movement of the testes down from the posterior abdominal wall into the scrotum during development

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103
Q

Who has an inguinal canal?

A

Both males and females

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104
Q

What is the entrance (abdominal) to the inguinal canal called?

A

The deep ring

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105
Q

What is the exit (Testicular) of theinguinal canal called?

A

Superficial ring

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106
Q

Describe the anatomical location of the deep ring

A

It is located superior to the midpoint of the inguinal ligament

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107
Q

Describe the anatomical location of the superficial ring?

A

This lies super-lateral to the pubic tubercle

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108
Q

What structure forms the floor of the inguinal canal?

A

The medial half of the inguinal ligament

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109
Q

What structure guides the testes down through the abdominal wall?

A

The gubernaculum, a string like structure

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110
Q

What is the name given to the space with which the testes descend?

A

The vaginal process (Processes vaginalis)

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111
Q

What is the function of the vaginal process (Processus vaginalis)?

A

It reduces friction on the testicle as it descends

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112
Q

What becomes of the gubernaculum in males?

A

It forms the spermatic cord (Testicular ligament)

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113
Q

What is contained in the spermatic cord?

A

Testicular artery
Vas deferens
Pampiniform plexus of veins

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113
Q

What is contained in the spermatic cord?

A

Testicular artery
Vas deferens
Pampiniform plexus of veins

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114
Q

What becomes of the gubernaculum in females?

A

It forms the round ligament of the uterus

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115
Q

What happens to the layers of the body wall as the testicles descend?

A

The layers move with it forming some important structures of the scrotum

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116
Q

How are organs of the abdomen classified?

A

By their embryological origin

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117
Q

What are the 3 classifications of abdominal organs?

A

Foregut
Midgut
Hindgut

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118
Q

What structures are found in the foregut?

A

Oesophagus
Stomach
Liver
Gallbladder
Spleen
Medial 1/2 pancreas
Proximal 1/2 duodenum

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119
Q

What structures are found in the midgut?

A

Distal 1/2 duodenum
Lateral 1/2 pancreas
Jejunum
Ileum
Caecum
Appendix
Proximal 2/3rd transverse colon

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120
Q

What structures are found in the hindgut?

A

Distal 1/3 transverse colon
Descending colon
Sigmoid colon
Rectum
Proximal 1/2 anal canal

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121
Q

What are the 3 midline branches of the abdominal aorta?

A

Coeliac trunk
Superior mesenteric artery
Inferior mesenteric artery

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122
Q

What structures are supplied by the lateral branches of the abdominal aorta?

A

Kidneys (Renal artery)
Gonads:
Testicles (Testicular artery)
Ovaries (Ovarian artery)
Body wall

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123
Q

At what level does the abdominal aorta bifurcate?

A

L4

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124
Q

At what levels does the coeliac trunk exit the abdominal aorta?

A

T12

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125
Q

Is the coeliac trunk retro or intra-peritoneal?

A

Retroperitoneal

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126
Q

What are the 3 initial branches of the coeliac trunk?

A

Splenic artery
Hepatic artery
Left gastric artery

127
Q

Describe the course of the splenic artery

A

The splenic artery has a tortuous course across the superior border of the pancreas and posterior surface of the stomach

128
Q

What organs are supplied by the splenic artery and its branches?

A

Spleen
Stomach
Pancreas

129
Q

What branches of the splenic artery supply the stomach?

A

Short gastric artery
Posterior gastric artery
Left gastro-mental artery

130
Q

What branches of the splenic artery supply the pancreas?

A

Pancreatic arteries

131
Q

What artery does the left gastro-momental artery anastomose with and where?

A

It anastomoses with the right gastro-momental on the inferior surface of the stomach

132
Q

What organs are supplied by the hepatic artery?

A

Liver
Gallbladder
Pancreas
Stomach
Duodenum

133
Q

What branches of the hepatic artery supply the liver?

A

The hepatic artery proper, which bifurcates into the left and right hepatic artery

134
Q

What are the 5, 1st line branches of the hepatic artery?

A

Right hepatic artery
Left hepatic artery
Right gastric artery
Gastroduodenal artery
Supraduodenal artery

135
Q

What are the 2, 2nd line branches of the gastroduodenal artery?

A

Right gastro-ommental artery
Superior pancreaticoduodenal artery

136
Q

What are the 2 main branches of the superior pancreaticoduodenal artery?

A

Posterior superior pancreaticoduodenal artery
Anterior superior pancreaticoduodenal artery

137
Q

What artery does the left gastric artery anastomose with and where?

A

With the right gastric artery on the superior surface of the stomach

138
Q

At what level does the superior mesenteric artery leave the abdominal aorta

A

L1

139
Q

What are the 7 main branches of the superior mesenteric artery?

A

Inferior pancreatic duodenal
Middle colic artery
Right colic artery
Ileocolic artery
Jejunal arteries
Ileal arteries
Appendicular artery

140
Q

What are the 2 main branches of the inferior pancreaticoduodenal arteries?

A

Anterior inferior pancreaticoduodenal
Posterior inferior pancreaticoduodenal

141
Q

What structures are formed by the arteries of the superior and inferior mesenteric arteries?

A

Arterial arcades (Loops)

142
Q

What is the name of the arteries that connect the arterial arcades to the intestinal wall?

A

Vasa recta

143
Q

At what level does the inferior mesenteric artery leave the abdominal aorta?

A

L3

144
Q

What are the 3 main branches of the inferior mesenteric artery?

A

Left colic
Sigmoid colic
Superior rectal

145
Q

What is the name of the artery that anastomoses the branches of the superior and inferior mesenteric arteries?

A

Marginal artery of Drummond

146
Q

What is the name of the line in the anal canal that marks the division between viscera and soma?

A

Pectinate line

147
Q

What artery supplies structures of the anal canal superior to the pectinate line?

A

Superior rectal artery of the inferior mesenteric artery

148
Q

What arteries supply the structures of the anal canal inferior to the pectinate line?

A

Middle and inferior rectal arteries of the internal ileac artery

149
Q

What is haematemesis?

A

Presence of blood in the vomitus

150
Q

What are the 2 venous systems of the body?

A

Hepatic portal system
Systemic venous system

151
Q

What are the 3 main veins of the GI tract that form the hepatic portal vein?

A

Splenic vein
Superior mesenteric vein
Inferior mesenteric vein

152
Q

Where does the inferior mesenteric vein drain into?

A

Splenic vein

153
Q

Where does the superior mesenteric vein drain into?

A

Hepatic portal vein

154
Q

Where does the splenic vein drain into?

A

Hepatic portal vein

155
Q

Where does the hepatic portal vein drain into?

A

Liver

156
Q

What vein drains blood form the hepatic veins of the liver to the heart?

A

Inferior vena cava

157
Q

Where are the 3 portal systemic anastomoses?

A

Distal end of oesophagus
Skin around umbilicus
Rectum and anal canal

158
Q

What is meant by a portal systemic anastamosis?

A

These are clinically important sites of anastomoses, containing collateral veins with no valves, meaning blood can flow either way

159
Q

Where does blood from the superior part of the distal oesophageal portal systemic anastomosis drain into?

A

Azygous vein

160
Q

Where does blood from the inferior part of the distal oesophageal portal systemic anastomosis drain into?

A

Left gastric vein and then the hepatic portal vein

161
Q

Where does blood from the superior part of the rectal portal systemic anastomosis drain into?

A

Inferior mesenteric vein

162
Q

Where does blood from the inferior part of the rectal portal systemic anastomosis drain into?

A

Internal iliac vein

163
Q

What happens to the portal systemic anastomoses in portal hypertension?

A

As there are no valves, blood will be forced into them and back into systemic circulation
This is cause dilatation and they will become varicose

164
Q

What is the name given to varicose veins around the umbilicus?

A

Caput medusae

165
Q

What are the 3 variceal consequences of portal hypertension?

A

Oesophageal varices
Caput medusae
Rectal varices

166
Q

What is jaundice?

A

This is a condition caused by a build up of bilirubin in the body, resulting in yellowing of the skin and eyes

167
Q

What is bilirubin?

A

Bilirubin is a normal by-product of the breakdown of red blood cells by the spleen and is a constituent of bile

168
Q

What are the 3 structures of the portal triad?

A

Hepatic artery
Hepatic portal vein
Common bile duct

169
Q

In what quadrant is the liver mostly found?

A

Upper right quadrant

170
Q

Describe the relation of the liver to the diaphragm?

A

The diaphragm lies superiorly, anteriorly and posteriorly to the liver

171
Q

Describe the relation of the liver to the gallbladder?

A

The gallbladder lies posteriorly and inferiorly to the liver

172
Q

Which ribs protect the liver?

A

Ribs 7-11

173
Q

What are the 4 anatomical lobes of the liver?

A

Right lobe
Left lobe
Caudate lobe
Quadrate lobe

174
Q

Where are the caudate and quadrate lobe of the liver found?

A

They are found on the inferior surface of the liver

175
Q

Which lobe (Caudate or quadrate) is found more anteriorly and lies next to the gallbladder?

A

Quadrate lobe

176
Q

What is the name given to the ligament that runs across the superior border of the right liver lobe?

A

Right coronary ligament

177
Q

What is the name given to the ligament that runs across the superior border of the left liver lobe?

A

Left coronary ligament

178
Q

What is the name given to the ligament that runs in the divide between the left and right lobes?

A

Falsiform ligament

179
Q

What is the name of the embryological ligament that hangs inferiorly from the falciform ligament?

A

Ligamentum teres (Round ligament)

180
Q

What embryological structure forms the ligamentum teres (Round ligament)?

A

Umbilical vein

181
Q

How many functional segments of the liver are there?

A

8

182
Q

How many main hepatic veins are there?

A

3

183
Q

What feature of veins do the hepatic veins and IVC lack?

A

Valves

184
Q

What are the 2 important recesses relating to the liver?

A

Sub-phrenic recess
Hepatorenal recess (Morrison’s pouch)

185
Q

Where is the sub-phrenic recess found?

A

Between the anterior diaphragm and the liver

186
Q

Where is the hepatorenal recess (Morrison’s pouch) found?

A

Between the right kidneys and liver posteriorly

187
Q

In which sac of the peritoneal cavity are the sub-phrenic recess and hepatorenal recess found?

A

The greater sac

188
Q

What is clinically important about the hepatorenal recess (Morrison’s pouch)?

A

It is one of the lowest points of the peritoneal cavity when a patient is supine

189
Q

Via which duct does bile enter and leave the gallbladder?

A

Cystic duct

190
Q

What causes the gallbladder to contract?

A

Cholecystokinin (CCK) and parasympathetic stimulation

191
Q

What artery carries blood to the gallbladder?

A

Cystic artery

192
Q

Which artery branches to form the cystic artery in 75% of people?

A

Hepatic artery

193
Q

How does bile move through the liver?

A

Via inter-hepatic ducts

194
Q

Describe the path of bile from the liver to the gallbladder

A

Inter-hepatic ducts =>
Left and right hepatic ducts =>
Common hepatic duct =>
Cystic duct =>
Gallbladder

195
Q

Describe the path of bile from the gallbladder to the duodenum

A

Cystic duct =>
Common bile duct =>
Ampulla of vater =>
Major Duodenal papilla =>
Duodenum

196
Q

What 2 structures join to form the common bile duct?

A

Cystic duct
Common hepatic duct

197
Q

What is the ampulla of vater?

A

The joining of the pancreatic duct and the common bile duct

198
Q

Where is the major duodenal papilla?

A

In the 2nd part (Descending) duodenum

199
Q

What are the 3 smooth muscle sphincters of the ampulla of vater?

A

Bile duct sphincter
Pancreatic duct sphincter
Sphincter of Odd

200
Q

Is the pancreas retro or intra-peritoneal?

A

Retroperitoneal

201
Q

What are the 4 main regions of the pancreas?

A

Head
Neck
Body
Tail

202
Q

What is the process of the head of the pancreas called?

A

Uncinate process

203
Q

Describe the position of the stomach in relation to the pancreas

A

The stomach is found anterior to the pancreas

204
Q

What nerve provides the pancreas with parasympathetic innervation?

A

Vagus nerve

205
Q

What nerves supply the pancreas with sympathetic innervation?

A

Abdominopelvic splanchnic nerves

206
Q

What are the 3 regions of the small intestine?

A

Duodenum
Jejunum
Ileum

207
Q

What are the 4 regions of the duodenum?

A

Superior
Descending
Horizontal/inferior
Ascending

208
Q

At what structure does the duodenum begin?

A

At the duodenal cap at the pyloric sphincter

209
Q

At what structure does the duodenum end?

A

Duodenojejunal flexure

210
Q

What effect does parasympathetic stimulation have on the pyloric sphincter?

A

Relaxation - Opening

211
Q

at effect does sympathetic stimulation have on the pyloric sphincter?

A

Contraction - Closing

212
Q

Where will pain from a duodenal ulcer be felt?

A

IN the epigastric region

213
Q

What artery supplies the superior and descending parts of the duodenum?

A

Branches of the superior pancreaticoduodenal and supra duodenal artery

214
Q

What artery supplies the horizontal and ascending parts of the duodenum?

A

Branches of the inferior pancreaticoduodenal arteries

215
Q

In what quadrant is the jejunum mostly found?

A

Upper left quadrant

216
Q

In what quadrant is the ileum mostly found?

A

lower right quadrant

217
Q

Where does the ileum end?

A

At the ileocaecal valve at the ileocaecal junction

218
Q

What differentiates the ileum and jejunum?

A

The jejunum contains more, larger place circularis
The jejunum has fewer arterial arcades with longer vasa recta
The ileum contains fewer, if any, lice circularis and contains more arterial arcades with shorter vasa recta

219
Q

What is found running between the ascending and descending colon and the body wall?

A

Pancolic gutters

220
Q

Which sac of the peritoneal cavity are the paracolic gutters found in?

A

Greater sac

221
Q

What is the name given to the 3 columns of smooth muscle running along the large colon?

A

Teniae coli

222
Q

What is the name given to the small fatty streaks that attach to the teniae coli?

A

Epiploic appendages

223
Q

What is the name given to the physiological in-pouchings of the large colon?

A

Haustra

224
Q

What 4 factors are required for the control of faecal excretion?

A

Storage area
Visceral afferent nerve fibres
Functioning muscular sphincters
Normal cerebral function

225
Q

What are some neurological conditions that can affect faecal continence?

A

Dementia
Stroke
Multiple Sclerosis
Traume (e.g. spinal cord injury, childbirth)

226
Q

What are some non-neurological factors that can affect faecal continence?

A

Medication
Age
Stool consistency

227
Q

What does the pelvic floor divide?

A

The pelvic cavity and perineum

228
Q

Is there is physical divide between the pelvic cavity and abdominal cavity?

A

No

229
Q

What is the name given to the pelvic floor muscle?

A

Levator ani

230
Q

At what level can the rectosigmoid junction be found?

A

S3

231
Q

At what levels does the rectum form the anal canal?

A

Just past the tip of the coxyx

232
Q

Which GI structures are found in the perineum?

A

Anal canal
Anus

233
Q

What is the rectal ampulla?

A

A widening of the rectum found just before the anal canal

234
Q

What are the 3 in-pouchings of the rectum called?

A

Superior rectal valve
Middle rectal valve
Inferior rectal valve

235
Q

What is the difference between the pelvic diaphragm and pelvic floor?

A

The pelvic diaphragm is the name given to the muscle and fascia of the pelvic floor, which contains other levels

236
Q

What are the 3 smaller muscles that make up the levator ani muscle?

A

Ruborectalis
Pubococcygeus
Iliococcygeus

237
Q

What type of muscle makes up the levator ani?

A

Skeletal muscle (voluntary)

238
Q

What affect does increased intra-abdominal pressure have on the levator ani?

A

It causes increased sympathetic tone, therefore causing contraction of the levator ani

239
Q

What are the 2 main nerves that supply the levator ani?

A

Nerve to levator ani
Pudendal

240
Q

What spinal nerves make up the pudendal nerve?

A

Anterior rami of S2, 3 and 4 (S2, 3 and 4 keeps the anus off the floor)

241
Q

Where does the nerve to levator ani originate?

A

Sacral plexus

242
Q

How does the puborectalis form a sphincter?

A
243
Q

What forms the anorectal angle?

A

The anorectal angle is formed by the puborectalis muscle, pulling the anal canal forward from the rectum, towards the pubic symphysis

244
Q

How many anal sphincters are there?

A

2

245
Q

What are the 2 types of anal sphincter?

A

Internal anal sphincter
External anal sphincter

246
Q

What type of muscle forms the internal anal sphincter?

A

Smooth muscle (Involuntary)

247
Q

What type of muscle forms the external anal sphincter?

A

Skeletal muscle

248
Q

What region of the anal canal is covered by the internal anal sphincter?

A

Superior 2/3rds

249
Q

hat region of the anal canal is covered by the external anal sphincter?

A

Inferior 2/3rds

250
Q

What nerve stimulates contraction of the external anal sphincter?

A

Pudendal nerve

251
Q

What type of nerve innervation stimulates contraction of the internal anal sphincter?

A

Sympathetic stimulation causes contraction of the internal anal sphincter

252
Q

What type of nerve innervation stimulates relaxation of the internal anal sphincter?

A

Parasympathetic stimulation causes relaxation of the internal anal sphincter

253
Q

True or false: The parasympathetic innervation can override the sympathetic innervation of the internal anal sphincter

A

True

254
Q

From what spinal levels does sympathetic innervation to the internal anal sphincter come from?

A

T12 - L2

255
Q

From what spinal level does parasympathetic innervation to the internal anal sphincter come from?

A

S2 - S4

256
Q

What is the function of visceral afferent nerves in the rectum?

A

They detect fullness of the rectum and control opening and closing of the internal anal sphincter

257
Q

Describe the route of the pudendal nerve

A

Formed by the anterior rami of S2, 3 and 4
Passes out of the greater sciatic foramen
Passes into the perineum and branches to supply the peritoneum

258
Q

How can labour cause faecal incontinence?

A

Labour can strecth and damage the nerve fibres of the pudendal nerve
Labour and an episiotomy can also damage the muscle itself

259
Q

What is the pectinate line?

A

This is the division between the viscera and body wall in the anal canal

260
Q

What structures are found just above the pectinate line?

A

Small anal columns, above anal recesses, and anal glands

261
Q

Describe the nerve innervation of structures above the pectinate line

A

Autonomic nerve supply

262
Q

Describe the nerve innervation of structures below the pectinate line

A

Somatic and pudendal nerve supply

263
Q

Where do structure above the pectinate line drain their lymphatics into?

A

Inferior mesenteric nodes

264
Q

Where do structures below the pectinate line drain their lymphatics into?

A

Superficial inguinal nodes

265
Q

What are the 3 main groups of lymph nodes within the pelvis?

A

Internal iliac nodes
External iliac nodes
Common iliac nodes

266
Q

What are the ischioanal fossae?

A

These are fat and loose tissue flled spaces either side of the anal canal, between which communications run

267
Q

What is an infection of the ischioanal fossae known as?

A

Ischioanal abscess

268
Q

What is herniation?

A

The movement of a structure through another, ending up in the wrong place

269
Q

What 2 things are required for herniation?

A

Structural weakness
Increased pressure

270
Q

Where are some normal weaknesses of the abdominal cavity?

A

Diaphragm
Umbilicus
Inguinal canal
Femoral canal
Linea semilunaris
Linea alba

271
Q

What are some pathological weaknesses of the abdominal cavity?

A

Congenital diaphragmatic hernia
Surgical scars/incisional hernia

272
Q

What are some common causes of increased pressure that can lead to herniation?

A

Chronic cough
Pregnancy
Strenuous exercise
Straining during defecation or urination

273
Q

What is an inguinal hernia?

A

These are hernias in which the small intestine passes through the inguinal canal

274
Q

What are the 2 types of inguinal hernia?

A

Direct inguinal hernia
Indirect inguinal hernia

275
Q

What is meant by a direct inguinal hernia?

A

This occurs when the small intestine is forced through the posterior wall of the inguinal canal and passes out through the superficial ring of the inguinal canal, bringing with it a sac of body wall

276
Q

What is the area through which a direct inguinal hernia will break through the abdominal wall?

A

Hesselbach’s triangle

277
Q

What makes up Hesselbach’s triangle?

A
  • Inferior epigastric artery
  • Lateral border of rectus abdominus
  • Inguinal ligament
278
Q

Direct inguinal hernias will push through …. to the inferior epigastric artery

A

Medially

279
Q

What is an indirect inguinal hernia?

A

These occur when the small intstine is forced through the deep ring and into theinguinal canal, before passing back out into the scrotum via the superficial ring

280
Q

Where can the inferior epigastric artery be found?

A

Half way between the pubic tubercle and anterior superior iliac spine

281
Q

How can the type of inguinal hernia be tested clinically?

A
  • Push hernia back in
  • Place thumb over deep ring (Between pubic tubercle and anterior superior iliac spine)
  • Ask patient to cough
  • Direct hernias will ‘pop’ back out
  • Indirect hernias will be stopped by your thumb
282
Q

Where is the sub-inguinal space found?

A

Beneath the inguinal ligament

283
Q

What is contained in the sub- inguinal space?

A

Femoral canal, allowing movement of hip flexors, the femoral artery, femoral vein, nerves and lymphatics

284
Q

What is the name given to the space of weakness in femoral hernia?

A

Myopectineal orifice

285
Q

What is a femoral hernia?

A

This is the movement of the small intestine through the femoral canal

286
Q

What types of nerves innervate the organs of the GI tract?

A

Visceral afferent
Sympathetic
Parasympathetic
Enteric

287
Q

What types of nerve innervate the body wall?

A

Somatic sensory
Somatic motor
Sympathetic

288
Q

Where do sympathetic nerves exit the spinal cord?

A

T1 - L2

289
Q

Which sympathetic spinal nerves mostly supply the GI tract?

A

T5 - L2

290
Q

Describe the route of sympathetic action potentials from the spinal cord to the GI tract

A

Pass into sympathetic trunks
Do not synapse
Form the abdominopelvic splanchnic nerves
Join the pre-vertebral ganglia at the abdominal aorta branches
Travel to organs along the aortic branches

291
Q

What is the periarterial plexus?

A

This is a plexus of sympathetic, parasympathetic and visceral afferent nerves found on the abdominal aorta

292
Q

Describe the pathway of sympathetic action potentials to the adrenal gland

A

The sympathetic nerve fires for the adrenal gland leaves the spinal cord (T10-L1), enters the thoracic splanchnic nerves, but does not synapse at the pre-vertebral ganglia, instead it carries on going with the periarterial plexus to the adrenal gland, synapsing directly onto the cells

293
Q

What nerves supply most of the GI tract with parasympathetic innervation?

A

Vagus nerve
Pelvic splanchnic nerves (S2,3 and 4)

294
Q

What regions of the GI tract are supplied by the vagus nerve?

A

All GI organs up to the distal end of the transverse colon

295
Q

What regions of the GI tract are supplied by the pelvic splanchnic nerves?

A

Between the distal end of the transverse colon to the pectinate line

296
Q

What nerves supply the body wall of the abdomen?

A

Thoracoabdominal nerves
Subcostal nerve
Iliohypogastric nerve
Ilioinguinal nerve

297
Q

Where do the thoracoabdominal nerves arise from?

A

They are extensions of the intercostal nerves of ribs 7-11 which then move down into the abdomen, travelling between the internal oblique and transversus abdominus muscles

298
Q

Where does the subcostal nerve arise form?

A

T12 anterior ramus

299
Q

Where does the iliohypogastric nerve arise?

A

Half of the L1 anterior ramus

300
Q

Where does the ilioinguinal nerve arise?

A

Half of the L1 anterior ramus

301
Q

Describe the pain referral patterns of the GI organs

A
302
Q

Where will pain from the foregut organs be felt?

A

Epigastric region

303
Q

Where will pain from the midgut organs be felt?

A

Ubilical region

304
Q

Where will pain from the hindgut organs be felt?

A

Suprapubic region

305
Q

Where do sensory nerve fibres from the foregut enter the spinal cord ?

A

T6 - T9

306
Q

Where do sensory nerve fibres from the midgut enter the spinal cord?

A

T8 - T12

307
Q

Where do sensory nerve fibres form the hindgut enter the spinal cord?

A

T10 - L2

308
Q

Why can pain from the gallbladder be felt in the right shoulder?

A

If the gallbladder becomes inflamed, it can rub on the diaphragm, stimulation the phrenic nerve, which enters the spinal cord at C3, 4 and 5

309
Q

How does ERCP work?

A

This involves insertion of an endoscope into the duodenum, which inserts a radiopaque dye into the major duodenal papilla, allowing the biliary tree to be imaged

310
Q

What type of vessel takes up chylomicrons in the gut?

A

Lacteals, which transport chylomicrons via the lymphatic system to the left venous angle

311
Q

What lymph nodes do the foregut organs drain to?

A

Coeliac nodes

312
Q

What lymph nodes do the midgut organs drain to?

A

Superior mesenteric nodes

313
Q

What lymph nodes so the hindgut organs drain to?

A

INferior mesenteric nodes

314
Q

What nodes do the kidneys, lower limbs and posterior abdominal wall drain to?

A

Lumbar nodes

Gastrointestinal (22 decks)

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