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Semester 4 Anatomy > GI Tract > Flashcards

GI Tract Flashcards

1
Q

Where does the oesophagus originate and terminate, and what levels are these?

A

Originate - cricoid cartilage C6

Terminate - cardiac orifice T11

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2
Q

Where does the oesophagus pass through the diaphragm?

A

T10 - oesophageal hiatus

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3
Q

What kind of sphincter is the LOS?

A

A physiological sphincter, formed by four phenomena:

  • oesophagus enters the stomach at an acute angle
  • positive intra-abdominal pressure
  • folds of mucosa aid in occluding the lumen
  • right crus of diaphragm has a ‘pinch-cock’ effect
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4
Q

Where does the foregut, midgut and hindgut start and end?

A

Foregut: stomach - duodenum proximal to 2nd part of duodenum (includes liver, gall bladder, pancreas and spleen)
Midgut: 2nd part of duodenum - distal 1/3rd of transverse colon
Highgut: distal 1/3rd of transverse colon - proximal anus

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5
Q

What is the main arterial supply to the foregut, midgut and hindgut?

A

Foregut - coeliac trunk
Midgut - superior mesenteric artery
Hindgut - inferior mesenteric artery

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6
Q

What are there 3 divisions of the coeliac trunk?

What level is the coeliac trunk?

A

Left gastric artery
Splenic artery
Common hepatic artery

Level of L1

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7
Q

At what level does the superior mesenteric artery arise?

A

Inferior of L1

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8
Q

At what level does the inferior mesenteric artery arise?

A

Inferior border of L3

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9
Q

Where do all the veins from the gut drain into?

What are the two veins that converge to make this vein?

A

Hepatic portal vein

Made by the meeting of: splenic vein and superior mesenteric vein

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10
Q

What is the lymphatic drainage of the different embryological structures in the gut:

A

Foregut - coeliac nodes
Midgut - superior mesenteric nodes
Hindgut - inferior mesenteric nodes

All these nodes drain into the intestinal trunk, which empties into the cysterna chyli at the end of the thoracic duct. The thoracic duct then drains into the venous system at the left subclavian vein

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11
Q

What is the autonomic sympathetic supply of the foregut?

A

Preganglionic fibres originate from T5-T9
Nerve fibres are carried in the greater splanchnic nerve
Fibres synapse at the coeliac ganglion

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12
Q

What is the autonomic sympathetic supply of the midgut?

A

Preganglionic nerve fibres arise from T10-T11
Nerve fibres are conveyed in the lesser splanchnic nerve
Fibres synpase at the superior mesenteric ganglion

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13
Q

What is the autonomic sympathetic supply of the hindgut?

A

Preganglionic fibres arise from T12-L1
Nerve fibres are conveyed in the lumbar splanchnic nerve
Fibres synapse at the inferior mesenteric ganglion

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14
Q

Where does referred pain from abdominal viscera perceived for the specific regions?

A

Foregut structures - epigastric region
Midgut structures - umbilical region
Hindgut structures - hypogastric region

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15
Q

What regions of the abdomen does the stomach lie in?

A

Epigastric, umbilical, left hypochondriac

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16
Q

What are the four main regions of the stomach?

A

Cardia
Fundus
Body
Pylorus

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17
Q

What is the cardial notch?

A

The superior angle created when the oesophagus enters the stomach

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18
Q

What is the angular incisure

A

A bend on the lesser curvature

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19
Q

What 2 things attach to the greater curvature of the stomach?

A

The gastrosplenic ligament

The greater omentum

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20
Q

What is the blood supply of the greater curvature of the stomach?

A

Short gastric arteries - supplies the fundus
Left gastro-omental artery - supplies the upper greater curvature
Right gastro-omental artery - supplies the lower greater curvature

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21
Q

What 2 things attach to the lesser curvature of the stomach?

A

Hepatogastric ligament

Lesser omentum

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22
Q

What is the blood supply of the lesser curvature of the stomach

A

Left gastric artery (branch of coeliac trunk) - supplies upper lesser curvature
Right gastric artery (branch of common hepatic artery) - supplies lower lesser curvature

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23
Q

What are the three muscular layers of the stomach?

A

Outer longitudinal
Middle circular
Inner Oblique muscle

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24
Q

What is the interior structure of the stomach composed of and what is their function?

A

Gastric folds - known as rugae.

They provide elasticity to the stomach, allowing it to expand and increase in volume without increasing in pressure

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25
Q

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

A

Once it has given off the gastroduodenal artery

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26
Q

From what branches do the right and left gastroepiploic arteries arise?

A

Right gastroepiploic - gastroduodenal artery

Left gastroepiploic - splenic artery

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27
Q

Where do the veins draining the stomach drain into?

A

Right and left gastric veins - drain into the hepatic portal vein
Short gastric vein, right and left gastroepiploic veins - drain into the superior mesenteric vein (which then drains into the hepatic portal vein)

28
Q

Name the three parts of the small intestine in order

A

Duodenum
Jejeunum
Ileum

29
Q

What are the 4 parts of the duodenum and what level are they found at?

A

Superior (L1)
Descending (L1-L3)
Inferior (L3)
Ascending (L3-L2)

30
Q

What is the most common site for ulceration in the duodenum?

A

Superior part

31
Q

What is the first part of the duodenum clinically referred as?

A

The duodenal cap

32
Q

Which part of the duodenum contains the major and minor duodenal papilla?

A

Second part (descending part)

33
Q

What enters the duodenum at the major and minor duodenal papilla’?

A

Major duodenal papilla - bile and pancreatic duct

Minor duodenal papilla - accessory pancreatic duct

34
Q

Which part of the duodenum does the transition from the foregut to the midgut occur?

A

2nd part (descending)

Just below the major duodenal papilla

35
Q

What is the longest section of the duodenum?

A

3rd part (inferior/horizontal)

36
Q

What structure is located at the duodejujunal flexure?

A

Suspensory muscle (ligament) of duodenum - when it contracts it widens the angle of the flexure to aid movement into the jejunum

37
Q

What are the 2 main arteries that supply the duodenum and which parts do they supply

A

Gastroduodenal - supplies proximal to the major duodenal papilla (foregut)

Superior mesenteric - supplies distal to the major duodenal papilla (midgut)

38
Q

What are the 3 branches of the gastroduodenal artery that supply the duodenum proximal to the major duodenal papilla?

A

Supraduodenal
Anterior superior pancreaticoduodenal
Posterior superior pancreaticoduodenal

39
Q

What are the 3 branches of the superior mesenteric artery that supply the duodenum distal to the major duodenal papilla?

A

Anterior inferior pancreaticoduodenal
Posterior inferior pancreaticoduodenal
First jejunal branch

40
Q

Where does the lymph from the duodenum drain?

A

Pancreatoduodenal nodes

Superior mesenteric nodes

41
Q

How are the the jejunum and ileum divided into fifths?

A

Jejunum - proximal 2/5ths

Ileum - distal 3/5ths

42
Q

What are the major differences between the jejunum and the ileum?

A

Jejunum is located in left upper quadrant, while the ileum is located in the right lower quadrant
Jejunum is darker (red), while the ileum is lighter (pink)
Jejunum has thicker walls, ileum has thinner walls
Jejunum has lots of plicae circulares, Ileum has few plicae circulares
Jejunum has less fat in mesentery, ileum has more fat in mesentery

43
Q

What is the blood supply to the jejeunum and ileum and how does it differ?

A

Both are supplied by the superior mesenteric artery branches forming arcades and vasa recta
Jejunum - less arcades and longer vasa recta
Ileum - more arcades and shorter vasa recta

44
Q

Is the cecum an intraperitoneal or retroperitoneal structure and why?

A

Intraperitoneal structure, because of its motility (not because it is is suspended by a mesentery)

45
Q

What is the appendix attached to?

A

The cecum

It is also suspended from the terminal ileum by the mesoappendix

46
Q

How does the lumen of the appendix change during age?

A

It is wide in young childhood, narrow in adolescence is virtually obliterated by middle age

47
Q

Why are adolescents more prone to appendicitis?

A

Because at this age the appendix is narrow

48
Q

What are teniae coli?

A

Three distinct strips of muscle present on the large intestine (colon) formed from the outer longitudinal fibres of the Muscularis Externa

49
Q

What are epiploic appendages?

A

Small fat filled sacs that project from the outer wall of the colon

50
Q

What are the most common positions of the appendix?

A

Retrocaecal (behind the cecum) - 11 o clock

Subileal (parallel with the terminal ileum) - 3 o clock

51
Q

What is McBurney’s Point?

A

The junction of the lateral and middle 1/3rd of a line from the anterior superior iliac spine to the umbilicus

This is where the base of the appendix is, and people with appendicular problems may describe pain near this point

52
Q

What is the arterial supply of the cecum and appendix?

A

Ileocolic artery - a branch of the superior mesenteric artery

Splits into three branches:
Anterior and posterior cecel - Supplies the cecum
Appendicular artery - supplies the appendix

53
Q

Where does lymph from the cecum and appendix drain?

A

Upper and lower iliocolic lymph nodes

Both drain into the superior mesenteric lymph nodes

54
Q

What are there distinctive features of the colon?

A

Haustra
Taeniae coli
Epiploic appendages

55
Q

What structure is attached to the lower border of the transverse colon?

A

Greater omentum

56
Q

What is the arterial supply to the ascending colon?

A

Ileocolic artery - from superior mesenteric artery

Right colic artery - from superior mesenteric artery

57
Q

What is the arterial supply to the transverse colon?

A

Right colic artery - from superior mesenteric artery
Middle colic artery - from superior mesenteric artery
Left colic artery - from inferior mesenteric artery

58
Q

What is the arterial supply to the descending colon?

A

Left colic artery - branch from inferior mesenteric artery

59
Q

At what vertebral level does the rectum lie?

A

S3-S5 and the coccyx

60
Q

What are the two major flexures in the rectum?

A

Sacral flexure - follows the curve of sacrum and coccyx
Anorectal flexure - the angle where the rectum pieces the diaphragm (formed by the pulling of the puborectalis portion of the levator ani muscle)

61
Q

How do the pouches behind the rectum differ in males and females?

A

Males - rectovesical pouch

Females - rectouterine pouch

62
Q

What is the arterial supply to the rectum?

A

Superior rectal artery - from inferior mesenteric artery
Middle rectal artery - from the internal iliac artery
Inferior rectal artery - from internal pudendal artery

63
Q

What is the venous drainage of the rectum?

A

Superior rectal vein - drains into portal system
Middle and inferior rectal vein - drains into systemic venous system

(This is a site of portocaval anastomosis)

64
Q

What are the 2 sphincters present in the anal canal and how are they controlled?

A

Internal anal sphincter - upper 2/3rds of anal canal (controlled by involuntary smooth muscle)

External anal sphincter - lower 2/3rds of anal canal (controlled voluntarily by skeletal puborectalis muscle)

65
Q

What is the anorectal ring?

A

This is found at the junction of the rectum to the anal canal and is formed by the fusion of the internal anal sphincter, external anal sphincter and the puborectalis muscle

66
Q

What is the internal structure of the anal canal

A

Mucosa is organised into anal columns, which are joined inferiorly by anal valves.

The anal valves form an irregular circle called the pectinate line, which divides the anus into upper and lower parts

67
Q

What is the arterial supply to the anal canal?

A

Above pectinate line - superior rectal artery (branch of inferior mesenteric)

Below pectinate line - inferior rectal artery (branch of internal pudendal artery)

Semester 4 Anatomy (9 decks)

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