GI tract and abdominal viscera Flashcards
1
Q
What is the division of the foregut and midgut is distinguished by?
A
The ampulla of Vater (common bile and pancreatic duct)
duodenal papilla
2
Q
What controls secretions from the ampulla of vater?
A
Sphincter of Oddi
3
Q
What spinal levels does the foregut receive sympathetic innervation from and receive visceral afferents from?
A
T5-T9 levels
4
Q
What sympathetic nerve principally supplies the foregut, what organs does it innervate?
A
Greater splanchnic nerve to coeliac ganglia
Postganglionic innervates liver, spleen, stomach and duodenum
5
Q
What is the division between the midgut and hindgut?
A
Approximately 2/3 along the transverse colon
6
Q
What spinal levels does the midgut receive sympathetic innervation from and receive visceral afferents from?
A
T10-T11 levels
7
Q
What sympathetic nerve principally supplies the midgut, what organs does it innervate?
A
Lesser splanchnic nerve to the superior mesenteric ganglia
Postganglionic innervates part of the small intestine, ascending colon and part of the transverse colon.
8
Q
What spinal levels does the hindgut receive sympathetic innervation from and receive visceral afferents from?
A
L1 level
9
Q
What sympathetic nerve principally supplies the hindgut, what organs does it innervate?
A
Lumbar splanchnic nerves to inferior mesenteric ganglion
Postganglionic innervates the descending colon, sigmoid colon and rectum.
10
Q
What is the principle blood supply to foregut, midgut and hindgut?
A
Foregut - coeliac artery
Midgut - superior mesenteric artery
Hindgut - inferior mesenteric artery
11
Q
What is the parasympathetic innervation of the GI tract?
A
Vagus (X) up to the transverse colon
Then pelvic splanchnic nerves (S2-S4)
12
Q
What makes up the abdominopelvic cavity?
A
Abdomen proper
Pelvic cavity
13
Q
What is the peritoneum?
A
Serous membrane which lines the walls of the abdominopelvic cavity and covers the abdominopelvic organs.
14
Q
What are the two layers of the peritoneum?
A
Inner visceral and outer parietal
15
Q
What is the histological appearance of the peritoneum?
A
Layer of squamous mesothelium supported by a thin layer of connective tissue
16
Q
What is the space between the visceral and parietal perineum known as and what is in there?
A
Peritoneal cavity and within the cavity is a small amount of peritoneal fluid.
17
Q
What two parts divides the peritoneal cavity?
A
Greater and lesser sac
18
Q
What is the opening between the greater and lesser sac called?
A
Epiglotic foramen
19
Q
What gives the blood and nerve supply of the visceral peritoneum and why?
A
Becomes attached to, and part of, the structure of the organ itself.
The blood supply, lymphatic drainage and nerve supply of the visceral peritoneum are the same as those of organ it covers.
20
Q
What gives the blood and nerve supply of the parietal peritoneum?
A
Blood supply, lymphatic drainage and nerve supply of parietal peritoneum are the same as those of the associated abdominopelvic wall.
21
Q
Define intraperitoneal and retroperitoneal
A
Intraperitoneal: organ lies within the peritoneal space, suspended by mesentery
Retroperitoneal: organs lie in the retroperitoneal space behind (retro) the peritoneum - in contact with the posterior abdominal wall.
22
Q
What does it mean to be secondarily retroperitoneal?
A
Organs that were once suspended within the abdominal cavity by mesentery but migrated posterior to the peritoneum during the course of embryogenesis to become retroperitoneal.
23
Q
What is mesentery?
A
Where the organ is some distance from the posterior abdominal wall
The peritoneum is drawn into a double layer, a mesentery.
24
Q
What occupies the space between the two peritoneal layers of a mesentery, why is this good?
A
Fat, blood vessels, lymphatics and nerves
Can reach the gastrointestinal tract without piercing the peritoneum.
25
Which structures are retroperitoneal?
```
Suprarenal (adrenal)
Aorta + IVC
Duodenum (2nd and 3rd)
Pancreas (not tail)
Ureter
Colon (descending and ascending)
Kidney
Esophagus
Rectum
```
26
Which organs are intraperitoneal?
Ileum, jejunum, transverse and sigmoid colon, liver and stomach, spleen, tail of pancreas
27
Describe nature and length of the oesophagus
25cm fibromuscular tube
28
What does oesophagus do?
Transports food form pharynx to stomach
29
Describe what oesophagus spans
Inferior border cricoid cartilage (c6), cardiac orifice of stomatch T11
30
Describe position of oesophagus in mediastinum
Posterior mediastinum
Passes through the diaphragm at T10
31
Describe what makes up the upper oesophageal sphincter and what it does
Cricopharyngeus muscle
| prevents air entering oesophagus
32
What is the junction between the stomach and oesophagus called?
Gastro-oesophageal junction
33
Where is the gastrooesophageal junction situated?
Left of T11 vertebra
34
What 5 features make up the lower oesophageal sphincter?
Oesophagus enters stomach at acute angle
Walls of intra-abdominal section of oesophagus can be compressed (when increase in intrabdominal pressure)
Folds of muscularis mucosa occlude lumen
Valve formed by circular muscle fibres at lower abdomen
Oesophagus narrows as it passes through right crus
35
Which part of diaphragm does oesophagus pass through?
Right crus
36
What is the purpose of lower oesophageal sphincter?
Prevent reflex of acidic gastric contents into oesophagus
37
What are 4 natural narrowings of oesophagus?
Cricopharyngeal sphincter
Where aortic arch crosses it
Where left main bronchus indents it
Diaphragmtic hiatus
38
What runs either side of cervical oesophagus?
Common carotid arteries
| Recurrent laryngeal nerves
39
What supplies cervical oesophagus?
Inferior thyroid artery
40
What drains cervical oesophagus?
Vertebral, brachiocephalic, inferior thyroid veins
41
What provides lymphatic drainage to cervical oesophagus?
Deep cervical nodes
42
What innervates cervical oesophagus?
Recurrent largneal and middle cerivcal ganglion (symp)
43
What 4 things is thoracic oesophagus anterior of?
T vertebrae
thoracic duct
azygous vein
descending aorta
44
What supplies thoracic oesophagus with blood?
Oeosphageal branches from aorta and bronchial arteries
45
What provides venous drainage to thoracic oesophagus?
Azygous and hemiazgous vein
46
What provides lymph drainage to thoracic oesophagus?
Tracheaobronchial and posteiror mediastinal nodes
47
What innervates thoracic oesophagus?
Vagus, greater splachnic nerve (symp)
48
What changes histologically at gastrooeosphageal junction?
Change from oesophageal to gastric mucosa
49
Is the abdominal oesophagus retroperitoneal or intraperitoneal?
Retroperitoneal
| Anterior surface covered with parietal peritoneum and abdominal oesophagus lies outside (behind) peritoneal cavity
50
Which arteries supply abdominal oesophagus?
Branches of left inferior phrenic and left gastric arteries
51
What drains abdominal oesophagus?
```
Left gastric vein (drains into portal system)
Azgous vein (drains into systemic)
```
52
What provides lymphatic drainage for abdominal oesophagus?
Left gastric and coeliac nodes
53
What innervates abdominal oesophagus?
Vagus
54
Which region of abdomen does stomach lie?
Left hypochondrium (superoir aspet of abdomen)
55
What does stomach do?
Break up food and mixes with secretions (e.g. pepsin, HCl, intrinsic fator)
56
What does stomach present to duodenum?
Chyme
57
What are the five regions of the stomach
```
Cardia
Fundus
Body
Antrum
Pylorus
```
58
What is fundus normally filled by?
Gas
59
What is fundus seen as on x-ray?
Gastric bubble
60
Which part of pylorus is widest?
Pyloric antrum
61
Where is pyloric sphincter, what does it do?
Junction with duodenum, regulates flow of stomach contents
62
What is pylorus crossed vertically by?
Crossed vertically by constant vein of mayo
63
When does stomach empty?
When intragastric pressure overcomes resistance of pylorus (controlled by nerves/hormones reflexes)
64
What happens in pyloric stenosis?
Narrowing of pyloric passage e.g. due to muscle hypertrophy. Leads to projectile vomiting, malnourishment
65
What does angular notch indicate?
Junction of body and pyloric region of stomach
66
What are omenta formed of?
Peritoneum folded over itself (i.e. 2 layers of peritoneum)
67
Where do gastric ulcers mainly occur?
Lesser curvature
68
What does greater omentum attach to?
Hangs from greater curvature and attaches to transverse colon
69
What does lesser omentum attach to?
Arises at lesser curvature and ascend to attach to liver
70
What is anterior to stomach?
Diaphragm and left lobe of liver
71
What is posterior to stomach?
Left kidney, spleen, aorta, coeliac trunk ,transverse mesocolon
72
What does greater omentum contain that helps with immunity?
Lymph nodes
73
Where does the greater omenta hang, what name is it given for this?
Lies superficial to the small intestine in the abdomen - fatty apron-like fold
74
What ligaments are subdivided from greater omentum?
Gastrosplenic omentum: stomach to the spleen,
Gastrophrenic ligament: stomach to underside of left dome of the diaphragm
Gastrocolic ligament: stomach to the transverse colon
Splenorenal ligament: the left kidney to the spleen (occasionally considered part of the greater omentum)
Phrenicosplenic ligament: thoracic diaphragm to spleen
75
What does the splenorenal ligament contain?
The splenic artery and vein
The tail of the pancreas, the only intraperitoneal portion of the pancreas.
76
What ligaments are subdivided from the lesser omentum?
Hepatogastric ligament: lesser curvature of the stomach to the liver.
Hepatoduodenal ligament: liver to the duodenum
77
What does the hepatoduodenal ligament contain?
Common bile duct, hepatic artery (proper) and hepatic portal vein
78
Describe blood supply to lesser curvature
Left and right gastric arteries anasotmose and run in lesser omentum
79
Describe blood supply to upper part of greater curvature?
Short gastric arteries + left gastroepiploic artery (both run in gastrosplenic ligmaent)
80
Describe blood supply to lower part of greater curvature
Right gastroepiploic runs in greater omentum
81
Describe venous drainage of the stomach?
Left and right gastric veins (lesser curvature) drain to portal vein direct
Left gastroepiploic and short gastric veins (upper greater curvature) drain into splenic veins
Right gastroepiploic vein (lower greater curvature) drains into superior mesenteric vein
(Splenic and superior mesenteric vein merge forming portal vein)
82
Describe lymph from stomach regions that drains into coeliac nodes.
Lesser curvature: left and right gastric nodes
Upper left side of greater curvature: splenic and pancreatic nodes
Lower greater curvature: gastroepiploic and pyloric nodes
83
Describe innervation to stomach
Symp fibres: coeliac plexus (T6-T9), nerves pass here via greater splachnic nerve
Para: vagus from anterior and posterior vagal trunks
84
Describe what anterior vagal trunk supply
Gastric branches, large hepatic branches and branches to pylorus
85
What does posterior trunk of vagus plexus supply?
Posterior stomach, large coeliac branch forms coeliac plexus.
86
Describe where small intestine extends to and from
Pylorus to ilecocaecal junction
87
What are 3 parts of small intestine?
Duodenum, jejunum, ileum
88
Four parts of duodenum
Superior, descending, inferior, ascending
89
What does duodenum wrap around?
Head of pancreas
90
Is duodenum retroperitoneal or intraperitoneal?
Retroperitoneal
91
What does duodenum receive?
Chyme from stomach, bile from gall bladder, pancreatic juices from pancreas
92
Level of superior duodenum?
L1
93
What small intestine site is most common for ulceration?
Superior duodenum (H Pylori)
94
What is posterior to superior duodenum?
Portal vein, common bile duct, IVC
95
What is anterior to superior duodenum?
Liver and gall bladder
96
What level is descending duodenum?
L1-L3
97
What does descending duodenum lie posterior to?
Transverse colon
98
What does descending duodenum lie anterior to?
Right kidney
99
What is major duodenal papilla?
Opening at which pancreatic secretions and bile secretions enter from ampulla of Vater
100
Where does accessory pancreatic duct enter duodenum?
Minor papilla above major one
101
What level is inferior duodenum?
L3
102
What does inferior duodenum cross over?
IVC and aorta
103
Level of ascending duodenum?
L2-L3
104
Where does duodenum join jejunum?
Duodenual flexure (L2)
105
What defines termination of duodenum
Fibromuscular peritoneal fold from right crus of diaphragm called suspensory ligament of Treitz
106
What widens angle of duodenojejunal flexure?
Contraction of suspensory ligmaent of Treitz
107
Describe blood supply to duodenum above and below duodenal papilla?
Foregut (above): superior pancreaticoduodenal
Midgut (below): inferior pancreaticoduodenal
108
Describe venous drainage of superior and inferior pancreaticoduodenal veins
Superior drains into hepatic portal vein
Inferior drains into superior mesenteric vein
109
What provides lymphatic drainage to duodenum?
Duodenal lymph drains to superior mesenteric and coeliac nodes
110
Describe sympathetic and parasympathetic supply to duodenum
Sympathetic: coeliac and superior mesenteric plexus
Parasympathetic: vagus
111
Are the jejunum and ileum intraperitoneal or retroperitoneal?
Intraperitoneal
112
How are jejunum and ileum attached to posterior abdominal wall?
Mesentery
113
True or false, no clear external demarcation between jejunum and ileum
True
114
Where does the jejunum begin?
Duodenojejunal flexure
115
Where does the ileum end?
Ileocaecal junction
116
What happens at the ileocaecal junction?
Ileum invaginates into caecum forming ilceoecal valve (separation of small and large intestine)
117
What does ileocaecal valve do?
Prevent reflux on enteric fluid from colon into small intestine
118
What is the caecum?
Intraperitoneal pouch that is beginning of large intestine
119
What is the role of the small intestine?
Terminal food digestion and nutrient absorption
120
Which has the thicker wall/thicker mucosa, jejunum or ileum?
Jejunum
121
Which has the shorter vasa recta, jejunum or ileum?
Ileum
122
Which has more arcades (anastomoses), jejunum or ileum?
Jejunum
123
Describe differences in arcades between jejunum and ileum?
Arcades more complex but shorter
124
Does the jejunum have a larger or smaller diameter than ileum?
Smaller
125
Which out of jejunum and ileum has less fat in mesentery?
Jejunum
126
Which out of jejunum and ileum has more densely packed circular folds?
Jejunum
127
Describe the span of the root of gut mesentery
Originates from posterior abdominal wall and runs diagonally down from L2 to right sacroiliac joint
128
What provides arterial supply to jejunum and ileum?
Superior mesenteric artery
129
Describe course of SMA
Arises from aorta at L1 and moves between layers of mesentery splitting into branches which anastomose to loops (arterial arcades)
130
What do vasa recta supply?
Individual section of small intestinal wall
131
Describe venous drainage of jejunum and ileum
Superior mesenteric vein
132
Where does SMV unite with another vein, what is formed?
Posterior to neck of pancreas (anterior to SMA) unites with splenic vein to form hepatic portal vien
133
Describe lymphatic drainage of jejunum and ileum
Mesenteric lymph nodes which drain into superior mesenteric lymph nodes (terminal ileum drains into ileocolic lymph nodes)
134
Describe innervation to small intestine
Parasympathetic and sympathetic from myenteric plexus + submucosal plexuses in intestinal walls
Parasympathetic from vagus
Sympathetic from Coeliac plexus via sympathetic prevertebral ganglia and greater splachnic nerves
135
What does the large intestine consist of?
Caecum, colon, rectum and anal canal.
136
What are the taeniae coli?
Longitudinal ribbons of smooth muscle on the outside of the ascending, transverse, descending and sigmoid colons
In the caecum are recognisable converging at the base of the appendix.
137
What are the four parts of the colon?
The ascending colon lies on the posterior abdominal wall (right lumbar region)
The descending colon is in a similar position in the left lumbar region.
The transverse colon is suspended from the posterior abdominal wall via peritoneum, and traverses the abdomen, connecting the ascending colon and the descending colon.
The sigmoid colon connects the descending colon to the rectum .
138
Describe the parasympathetic supply to the large intestine
The proximal two thirds of the transverse colon, is derived from the vagus nerves (X).
The preganglionic fibres synapse in the wall of the intestine in the submucosal and myenteric plexuses.
From the distal third of the transverse colon onwards the large intestine derives its parasympathetic supply from the pelvic splanchnic nerves (S2-4).
139
What does the IMV join?
The inferior mesenteric vein joins the splenic vein
140
Explain the lymphatic drainage of the large intestine
Drains via lymph nodes to the intestinal lymph trunk to cisterna chyli
Three groups of nodes:
One lies close to the intestinal wall
One lies along the branches of the main arteries supplying the large intestine
The third group lies on the main trunks of the superior and inferior mesenteric arteries.
141
What supplies the rectum?
Superior and inferior rectal artery
142
What veins drain from the rectum and anal canal?
The superior, middle and inferior rectal veins.
143
What spinal level is the rectosigmoidal junction?
S3
144
How is the peritoneum arranged around the rectum?
The superior third of the rectum has peritoneum covering the anterior and lateral surfaces only
The middle third has peritoneum covering its anterior surface
The inferior third has no peritoneal coverings (the rectum is now ‘subperitoneal’).
145
Why is there no peritoneal covering to the posterior rectum?
It is in contact with the sacrum
146
What are the two anatomical lobes of the liver?
Left and right lobe
147
What two smaller lobes is the right lobe of the liver divided into?
Caudate and quadrate lobes
148
What is the visceral surface of the right lobe of liver in contact with?
Right suprarenal gland, the right kidney, IVC, the transverse colon.
149
What is the visceral surface of the left lobe of liver in contact with?
Stomach and oesophagus
150
What is the porta hepatis?
Deep fissure in the inferior surface of the liver through which all the neurovascular structures (except hepatic veins) and hepatic ducts enter or leave the liver
151
What gives blood supply to the liver?
Hepatic portal vein
Common hepatic artery (branch of coeliac)
152
When the common heptic artery reaches the porta hepatis, what does it do?
Divides into right and left branches then eventually to supply all 8 segments
153
What % of blood reaching the liver does the hepatic artery deliver?
20%
154
What drains the liver?
Blood in the liver sinusoids drains to the central veins of the liver lobules.
The central veins unite into larger veins eventually forming the main hepatic veins which drain all the blood from the liver into the inferior vena cava.
155
What is the falciform ligament and what does it attach?
The falciform ligament is a ligament that attaches the liver to the front body wall, and separates the liver into the left medial lobe and left lateral lobe.
156
Where is bile formed?
The liver
157
Where does bile drain out the liver, where do they emerge?
Hepatic ducts, emerge from porta hepatis
158
How does the liver join to the gall bladder?
Hepatic ducts merge into the common hepatic duct which drains into the gall bladder (via cystic duct)
159
What is the role of the gall bladder?
Collects and temporarily stores bile
160
How is bile conveyed to the duodenum?
When the gall bladder empties, its wall contracts forcing the bile back along the cystic duct.
The cystic duct joins with the common hepatic duct to form the common bile duct which conveys bile to the duodenum
161
Approximately how long is the pancreas?
~15cm
162
Is the pancreas retroperitoneal or intraperitoneal?
All retroperitoneal except the tail which is intraperitoneal
163
What are the sections of the pancreas?
Head, with an uncinate process, a neck, a body and a tail.
164
Where is the pancreas positioned on the posterior abdominal wall?
Slightly obliquely
165
Where does the main pancreatic duct arise from and enter?
The tail, enters the duodenum at the postromedial wall
166
What artery supplies the gall bladder?
Cystic artery
167
What artery supplies the pancreas?
Both coeliac and superior mesenteric arteries providing arterial blood
via right gastric, gastroduodenal, superior and inferior pancreaticoduodenal arteries.
Also pancreas receives a substantial blood supply by several pancreatic branches from the splenic artery.
168
True or false the pancreas receives blood supply from both the coeliac and SMA
True
169
What structures pass through the porta hepatis?
Common hepatic duct, hepatic artery, hepatic portal vein
170
What organ controls gall bladder contraction by endocrine mechanism?
Duodenum
171
What function does the liver have in the embryo?
Haemopoietic function
172
What are the functions of the large intestine?
Absorb water and store faeces before defacation
173
What 3 factors allow large intestine to be distinguished from small intestine?
Taeniae coli
Haustrae
Epiploic appendicies
174
When does smooth muscle of teniae coli terminate?
Rectum (S3)
175
What are epiploic appendicies?
Fat filled pouches attached to colon
176
What part of abdomen are caecum and appendix located?
Right iliac fossa
177
Is the cecum intra or retroperitnoeal?
Intraperitoneal
178
What is the widest part of the GI tract?
Caecum
179
Blood supply to caecum?
Midgut so ileocilic artery from SMA which divides to anterior and posterior cecal artries
180
How can appendix be distinguised from colon and caecum?
Lack of taeniae coli
Many lymphoid follicles
181
What is mesoappendix and where does it span?
Short triangular shaped mesentery from mesentery of terminal ileum to appendix
182
What does mesoappendix contain?
Appendicular vessels of ileocolic artery and vein
183
Lymph from where drains to mesoappendix, where does it go from there?
Appendix and caecum to nodes in mesoappendix then ileocolic nodes
184
Which plexus supplies the caecum and appendix?
Superior mesenteric plexus
185
What happens to the pain location in appendicitis?
Abdominal pain (T10 dermatome, periumbilical region). Visceral peritoneum inflamed.
Then located to Mcburney's point (one-third of the distance from the anterior superior iliac spine to the umbilicus) because parietal peritoneum becomes inflamed
186
What artery supplies appendix?
The SMA
Ileocolic artery
Appendicular artery
187
Where is McBurney's point?
1/3 the distance from anterior superior iliac spine to umbilicus
188
Is the ascending colon intraperitoneal or retroperitoneal?
Retroperitoneal (only covered by peritoneum anteriorly)
189
What is either side of ascending colon?
Paracolic gutters (spaces between colon and abdominal wall)
190
Is transverse colon retroperitneal or intraperitoneal?
Intraperitoneal
191
What is colon attached to at splenic flexure?
Phrenicocolic ligament
192
Where is diaphragm attached to GI tract? how?
At splenic flexure, between transverse colon via phrenicocolic ligament
193
What is mesocolon?
The part of the mesentery that attaches the colon to the abdominal wall.
194
Is the descending colon intraperitoneal or retroperitoneal?
Retroperitoneal
195
Where does descending colon extend to?
Sigmoid colon in left iliac fossa
196
Describe course of sigmoid colon (e.g. from which compartment to which spinal level)?
Left iliac fossa to S3
197
Is the sigmoid colon intraperitoneal or retroperitoneal?
Intraperitoneal
198
How is sigmoid colon attached to posterior pelvic wall?
Sigmoid mesocolon
199
What lies behind apex of sigmoid mesocolon?
Left Ureter as it crosses common iliac artery
200
What supplies ascending colon?
Ileocolic artery and right colic
201
What supplies transverse colon?
Right and middle colic, (from SMA) left colic (from IMA)
202
What supplies descending colon?
Left colic artery
203
What drains ascending colon?
Ilecolic and right colic veins into SMV
204
What drains transverse colon?
Middle colic vein into SMV
205
What drains descending colon?
Left colic vein into IMV
206
What drains sigmoid colon?
Sigmoid veins into IMV
207
Describe right side lymphatic drainage of colon
Inferior mesenteric noes to superior mesenteric and para aortic nodes
208
Describe left side lymphatic drainage of colon
Directly into superior mesenteric nodes
209
What do midgut structures receive sympathetic and sensory supply from?
Superior mesenteric plexus
210
What provides symp supply to midgut?
T10-L2 via lumbar sympathetic chain and presacral nerves. .
211
What plexus supplies hindgut?
Inferior mesenteirc plexus
212
What is parasympathetic supply to hindgut?
Pelvic splanchnic nerve S2-S4
213
What is sympathetic supply to hindgut?
Lumbar splanchnic nerve
214
What is anterior to rectum?
Bladder, distal uterus, prostate, posterior vaginal wall
215
What is posterior to rectum?
Sacrum, coccyx, lower sacral nerves
216
What is the intersphinteric groove, what does it mark?
Indentation of anal canal (marks area between external and internal sphincters)
217
What does dentate line mark (embryologically)?
Mucosa above dentate line endoderm, below is ectoderm
218
What specific things does dentate line mark?
Where epithelium changes from columnar to stratified squamous
Superior rectal artery to middle+inferior rectal artery
Endoderm to ectoderm
219
How do lymph and nerve supply vary across dentate line?
Above: lymph drainage is internal iliac
Below: superficial inguinal lymph nodes
Above: nerve from inferior hypogastric plexus (autonomic)
Below: inferior rectal nerves (pudendal nerves - somatic)
220
What supplies rectum and upper anal canal above dentate line?
Superior rectal artery
221
What supplies middle and inferior rectum, what does it branch from?
Middle rectal artery (branch of internal iliac)
222
What supplies lower half of anal canal, what does it branch from?
Inferior rectal artery (branch of internal pudendal artery of internal iliac)
223
Describe the anastomoses in rectal vasculature?
Anastomoses between branches of inferior mesenteirc and pudendal vessels
224
What does superior rectal vein drain, which part of plexus?
Anal canal above dentate line
| Superior part of internal and external plexus
225
What does middle rectal vein drain, where does it drain into?
Middle part of external plexus into internal iliac
226
What does inferior rectal vein drain, where does it drain into?
Inferior part of plexus
| Drains into internal pudendal vein
227
What do middle rectal veins anastomse with?
Superior and inferior rectal veins
228
Describe parasympathetic, sympathetic and sensory supply to rectum
Para: pelvic splachnic nerve (S2-S4)
Symp: plexuses of coeliac and hypogastric nerve
Visceral afferent fibres follow para supply
229
Describe lymph drainage of upper rectum
Lymph vessels follow superior rectal vein and drain to abdominal lymph nodes (para aortic)
230
Describe lymph drainage of lower rectum
Inguinal nodes
231
Describe upper anal canal lymph drainage
Internaliliac nodes
232
Describe lower anal canal lymph drainage?
Inguinal nodes
233
What vertebral level is the inferior horizontal part of the duodenum at?
L3
234
What vertebral level is the superior duodenal flexure at?
L1
235
What spinal level do visceral afferents from the ascending colon convey sensation to?
T10-T11 (umbilical)
236
What produces colons sacculated (haustra) appearance?
Infoldings of the mucosal layer of the gut in this region
237
Pathology in the sigmoid colon refers pain to which region?
Pubic
238
What is the suspensory ligament of triez derived from?
Right diaphragmatic crus
239
How far along the duodenum is the major papilla?
Mid-end of descending
240
What type of retroperitoneal is ascending colon?
Secondarily
241
What does the splenic artery give rise to?
Short gastric arteries and to the left gastroepiploic artery. (left greater curvature supply)
242
What does the right gastroepiploic artery arise from?
Common hepatic artery
Gastroduodenal artery
243
What region does the gall bladder lie in?
Epigastric
244
The hepatic portal vein reaches the liver via the free margin of the...
Lesser omentum
245
Blood from the liver drains to the...
IVC
246
The head of the pancreas is lies in the...
Umbilical region
247
The head of the pancreas surrounds the...
Superior mesenteric artery
248
Tail of the pancreas extends towards the...
Spleen
249
The free edge of the lesser omentum contains the
Portal triad of vessels (proper hepatic, common bile duct and portal vein)
250
Large intestine features distinct from small intestine
Taenia coli
Haustrations
Appendices epiploicae
251
Small intestine features distinct from large
Valvulae conniventes
| Villi
252
Appendicitis pain site
First periumbilical pain which then progresses to the right iliac fossa at Mc Burneys point (2/3 of way from umbilicus to ASIS)
253
Where does the cystic artery arise from?
Common hepatic - right hepatic - cystic
254
Relation of common bile duct to pancreas head
Posterior
255
Tail of the pancreas passes through
Splenorenal ligament
256
Calots triangle is formed by
Common hepatic duct, cystic duct and inferior edge of liver
257
What does carlots triangle demarkate the position of ?
Cystic artery
258
What liver ligament is a remnant of ventral mesentery in foetus?
Falciform
