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Gross anatomy > GI tract and abdominal viscera > Flashcards

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

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2
Q

What controls secretions from the ampulla of vater?

A

Sphincter of Oddi

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3
Q

What spinal levels does the foregut receive sympathetic innervation from and receive visceral afferents from?

A

T5-T9 levels

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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

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5
Q

What is the division between the midgut and hindgut?

A

Approximately 2/3 along the transverse colon

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6
Q

What spinal levels does the midgut receive sympathetic innervation from and receive visceral afferents from?

A

T10-T11 levels

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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.

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8
Q

What spinal levels does the hindgut receive sympathetic innervation from and receive visceral afferents from?

A

L1 level

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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.

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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

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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)

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12
Q

What makes up the abdominopelvic cavity?

A

Abdomen proper

Pelvic cavity

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13
Q

What is the peritoneum?

A

Serous membrane which lines the walls of the abdominopelvic cavity and covers the abdominopelvic organs.

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14
Q

What are the two layers of the peritoneum?

A

Inner visceral and outer parietal

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15
Q

What is the histological appearance of the peritoneum?

A

Layer of squamous mesothelium supported by a thin layer of connective tissue

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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.

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17
Q

What two parts divides the peritoneal cavity?

A

Greater and lesser sac

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18
Q

What is the opening between the greater and lesser sac called?

A

Epiglotic foramen

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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.

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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.

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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.

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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.

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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.

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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.

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25
Q

Which structures are retroperitoneal?

A 
Suprarenal (adrenal)
Aorta + IVC
Duodenum (2nd and 3rd)
Pancreas (not tail)
Ureter
Colon (descending and ascending)
Kidney
Esophagus
Rectum
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26
Q

Which organs are intraperitoneal?

A

Ileum, jejunum, transverse and sigmoid colon, liver and stomach, spleen, tail of pancreas

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27
Q

Describe nature and length of the oesophagus

A

25cm fibromuscular tube

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28
Q

What does oesophagus do?

A

Transports food form pharynx to stomach

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29
Q

Describe what oesophagus spans

A

Inferior border cricoid cartilage (c6), cardiac orifice of stomatch T11

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30
Q

Describe position of oesophagus in mediastinum

A

Posterior mediastinum

Passes through the diaphragm at T10

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31
Q

Describe what makes up the upper oesophageal sphincter and what it does

A

Cricopharyngeus muscle

prevents air entering oesophagus

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32
Q

What is the junction between the stomach and oesophagus called?

A

Gastro-oesophageal junction

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33
Q

Where is the gastrooesophageal junction situated?

A

Left of T11 vertebra

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34
Q

What 5 features make up the lower oesophageal sphincter?

A

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

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35
Q

Which part of diaphragm does oesophagus pass through?

A

Right crus

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36
Q

What is the purpose of lower oesophageal sphincter?

A

Prevent reflex of acidic gastric contents into oesophagus

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37
Q

What are 4 natural narrowings of oesophagus?

A

Cricopharyngeal sphincter
Where aortic arch crosses it
Where left main bronchus indents it
Diaphragmtic hiatus

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38
Q

What runs either side of cervical oesophagus?

A

Common carotid arteries

Recurrent laryngeal nerves

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39
Q

What supplies cervical oesophagus?

A

Inferior thyroid artery

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40
Q

What drains cervical oesophagus?

A

Vertebral, brachiocephalic, inferior thyroid veins

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41
Q

What provides lymphatic drainage to cervical oesophagus?

A

Deep cervical nodes

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42
Q

What innervates cervical oesophagus?

A

Recurrent largneal and middle cerivcal ganglion (symp)

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43
Q

What 4 things is thoracic oesophagus anterior of?

A

T vertebrae
thoracic duct
azygous vein
descending aorta

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44
Q

What supplies thoracic oesophagus with blood?

A

Oeosphageal branches from aorta and bronchial arteries

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45
Q

What provides venous drainage to thoracic oesophagus?

A

Azygous and hemiazgous vein

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46
Q

What provides lymph drainage to thoracic oesophagus?

A

Tracheaobronchial and posteiror mediastinal nodes

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47
Q

What innervates thoracic oesophagus?

A

Vagus, greater splachnic nerve (symp)

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48
Q

What changes histologically at gastrooeosphageal junction?

A

Change from oesophageal to gastric mucosa

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49
Q

Is the abdominal oesophagus retroperitoneal or intraperitoneal?

A

Retroperitoneal

Anterior surface covered with parietal peritoneum and abdominal oesophagus lies outside (behind) peritoneal cavity

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50
Q

Which arteries supply abdominal oesophagus?

A

Branches of left inferior phrenic and left gastric arteries

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51
Q

What drains abdominal oesophagus?

A 
Left gastric vein (drains into portal system)
Azgous vein (drains into systemic)
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52
Q

What provides lymphatic drainage for abdominal oesophagus?

A

Left gastric and coeliac nodes

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53
Q

What innervates abdominal oesophagus?

A

Vagus

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54
Q

Which region of abdomen does stomach lie?

A

Left hypochondrium (superoir aspet of abdomen)

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55
Q

What does stomach do?

A

Break up food and mixes with secretions (e.g. pepsin, HCl, intrinsic fator)

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56
Q

What does stomach present to duodenum?

A

Chyme

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57
Q

What are the five regions of the stomach

A 
Cardia
Fundus
Body
Antrum
Pylorus
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58
Q

What is fundus normally filled by?

A

Gas

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59
Q

What is fundus seen as on x-ray?

A

Gastric bubble

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60
Q

Which part of pylorus is widest?

A

Pyloric antrum

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61
Q

Where is pyloric sphincter, what does it do?

A

Junction with duodenum, regulates flow of stomach contents

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62
Q

What is pylorus crossed vertically by?

A

Crossed vertically by constant vein of mayo

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63
Q

When does stomach empty?

A

When intragastric pressure overcomes resistance of pylorus (controlled by nerves/hormones reflexes)

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64
Q

What happens in pyloric stenosis?

A

Narrowing of pyloric passage e.g. due to muscle hypertrophy. Leads to projectile vomiting, malnourishment

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65
Q

What does angular notch indicate?

A

Junction of body and pyloric region of stomach

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66
Q

What are omenta formed of?

A

Peritoneum folded over itself (i.e. 2 layers of peritoneum)

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67
Q

Where do gastric ulcers mainly occur?

A

Lesser curvature

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68
Q

What does greater omentum attach to?

A

Hangs from greater curvature and attaches to transverse colon

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69
Q

What does lesser omentum attach to?

A

Arises at lesser curvature and ascend to attach to liver

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70
Q

What is anterior to stomach?

A

Diaphragm and left lobe of liver

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71
Q

What is posterior to stomach?

A

Left kidney, spleen, aorta, coeliac trunk ,transverse mesocolon

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72
Q

What does greater omentum contain that helps with immunity?

A

Lymph nodes

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73
Q

Where does the greater omenta hang, what name is it given for this?

A

Lies superficial to the small intestine in the abdomen - fatty apron-like fold

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74
Q

What ligaments are subdivided from greater omentum?

A

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

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75
Q

What does the splenorenal ligament contain?

A

The splenic artery and vein

The tail of the pancreas, the only intraperitoneal portion of the pancreas.

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76
Q

What ligaments are subdivided from the lesser omentum?

A

Hepatogastric ligament: lesser curvature of the stomach to the liver.

Hepatoduodenal ligament: liver to the duodenum

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77
Q

What does the hepatoduodenal ligament contain?

A

Common bile duct, hepatic artery (proper) and hepatic portal vein

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78
Q

Describe blood supply to lesser curvature

A

Left and right gastric arteries anasotmose and run in lesser omentum

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79
Q

Describe blood supply to upper part of greater curvature?

A

Short gastric arteries + left gastroepiploic artery (both run in gastrosplenic ligmaent)

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80
Q

Describe blood supply to lower part of greater curvature

A

Right gastroepiploic runs in greater omentum

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81
Q

Describe venous drainage of the stomach?

A

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)

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82
Q

Describe lymph from stomach regions that drains into coeliac nodes.

A

Lesser curvature: left and right gastric nodes

Upper left side of greater curvature: splenic and pancreatic nodes

Lower greater curvature: gastroepiploic and pyloric nodes

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83
Q

Describe innervation to stomach

A

Symp fibres: coeliac plexus (T6-T9), nerves pass here via greater splachnic nerve

Para: vagus from anterior and posterior vagal trunks

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84
Q

Describe what anterior vagal trunk supply

A

Gastric branches, large hepatic branches and branches to pylorus

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85
Q

What does posterior trunk of vagus plexus supply?

A

Posterior stomach, large coeliac branch forms coeliac plexus.

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86
Q

Describe where small intestine extends to and from

A

Pylorus to ilecocaecal junction

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87
Q

What are 3 parts of small intestine?

A

Duodenum, jejunum, ileum

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88
Q

Four parts of duodenum

A

Superior, descending, inferior, ascending

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89
Q

What does duodenum wrap around?

A

Head of pancreas

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90
Q

Is duodenum retroperitoneal or intraperitoneal?

A

Retroperitoneal

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91
Q

What does duodenum receive?

A

Chyme from stomach, bile from gall bladder, pancreatic juices from pancreas

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92
Q

Level of superior duodenum?

A

L1

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93
Q

What small intestine site is most common for ulceration?

A

Superior duodenum (H Pylori)

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94
Q

What is posterior to superior duodenum?

A

Portal vein, common bile duct, IVC

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95
Q

What is anterior to superior duodenum?

A

Liver and gall bladder

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96
Q

What level is descending duodenum?

A

L1-L3

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97
Q

What does descending duodenum lie posterior to?

A

Transverse colon

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98
Q

What does descending duodenum lie anterior to?

A

Right kidney

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99
Q

What is major duodenal papilla?

A

Opening at which pancreatic secretions and bile secretions enter from ampulla of Vater

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100
Q

Where does accessory pancreatic duct enter duodenum?

A

Minor papilla above major one

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101
Q

What level is inferior duodenum?

A

L3

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102
Q

What does inferior duodenum cross over?

A

IVC and aorta

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103
Q

Level of ascending duodenum?

A

L2-L3

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104
Q

Where does duodenum join jejunum?

A

Duodenual flexure (L2)

105
Q

What defines termination of duodenum

A

Fibromuscular peritoneal fold from right crus of diaphragm called suspensory ligament of Treitz

106
Q

What widens angle of duodenojejunal flexure?

A

Contraction of suspensory ligmaent of Treitz

107
Q

Describe blood supply to duodenum above and below duodenal papilla?

A

Foregut (above): superior pancreaticoduodenal

Midgut (below): inferior pancreaticoduodenal

108
Q

Describe venous drainage of superior and inferior pancreaticoduodenal veins

A

Superior drains into hepatic portal vein

Inferior drains into superior mesenteric vein

109
Q

What provides lymphatic drainage to duodenum?

A

Duodenal lymph drains to superior mesenteric and coeliac nodes

110
Q

Describe sympathetic and parasympathetic supply to duodenum

A

Sympathetic: coeliac and superior mesenteric plexus
Parasympathetic: vagus

111
Q

Are the jejunum and ileum intraperitoneal or retroperitoneal?

A

Intraperitoneal

112
Q

How are jejunum and ileum attached to posterior abdominal wall?

A

Mesentery

113
Q

True or false, no clear external demarcation between jejunum and ileum

A

True

114
Q

Where does the jejunum begin?

A

Duodenojejunal flexure

115
Q

Where does the ileum end?

A

Ileocaecal junction

116
Q

What happens at the ileocaecal junction?

A

Ileum invaginates into caecum forming ilceoecal valve (separation of small and large intestine)

117
Q

What does ileocaecal valve do?

A

Prevent reflux on enteric fluid from colon into small intestine

118
Q

What is the caecum?

A

Intraperitoneal pouch that is beginning of large intestine

119
Q

What is the role of the small intestine?

A

Terminal food digestion and nutrient absorption

120
Q

Which has the thicker wall/thicker mucosa, jejunum or ileum?

A

Jejunum

121
Q

Which has the shorter vasa recta, jejunum or ileum?

A

Ileum

122
Q

Which has more arcades (anastomoses), jejunum or ileum?

A

Jejunum

123
Q

Describe differences in arcades between jejunum and ileum?

A

Arcades more complex but shorter

124
Q

Does the jejunum have a larger or smaller diameter than ileum?

A

Smaller

125
Q

Which out of jejunum and ileum has less fat in mesentery?

A

Jejunum

126
Q

Which out of jejunum and ileum has more densely packed circular folds?

A

Jejunum

127
Q

Describe the span of the root of gut mesentery

A

Originates from posterior abdominal wall and runs diagonally down from L2 to right sacroiliac joint

128
Q

What provides arterial supply to jejunum and ileum?

A

Superior mesenteric artery

129
Q

Describe course of SMA

A

Arises from aorta at L1 and moves between layers of mesentery splitting into branches which anastomose to loops (arterial arcades)

130
Q

What do vasa recta supply?

A

Individual section of small intestinal wall

131
Q

Describe venous drainage of jejunum and ileum

A

Superior mesenteric vein

132
Q

Where does SMV unite with another vein, what is formed?

A

Posterior to neck of pancreas (anterior to SMA) unites with splenic vein to form hepatic portal vien

133
Q

Describe lymphatic drainage of jejunum and ileum

A

Mesenteric lymph nodes which drain into superior mesenteric lymph nodes (terminal ileum drains into ileocolic lymph nodes)

134
Q

Describe innervation to small intestine

A

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
Q

What does the large intestine consist of?

A

Caecum, colon, rectum and anal canal.

136
Q

What are the taeniae coli?

A

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
Q

What are the four parts of the colon?

A

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
Q

Describe the parasympathetic supply to the large intestine

A

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
Q

What does the IMV join?

A

The inferior mesenteric vein joins the splenic vein

140
Q

Explain the lymphatic drainage of the large intestine

A

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
Q

What supplies the rectum?

A

Superior and inferior rectal artery

142
Q

What veins drain from the rectum and anal canal?

A

The superior, middle and inferior rectal veins.

143
Q

What spinal level is the rectosigmoidal junction?

A

S3

144
Q

How is the peritoneum arranged around the rectum?

A

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
Q

Why is there no peritoneal covering to the posterior rectum?

A

It is in contact with the sacrum

146
Q

What are the two anatomical lobes of the liver?

A

Left and right lobe

147
Q

What two smaller lobes is the right lobe of the liver divided into?

A

Caudate and quadrate lobes

148
Q

What is the visceral surface of the right lobe of liver in contact with?

A

Right suprarenal gland, the right kidney, IVC, the transverse colon.

149
Q

What is the visceral surface of the left lobe of liver in contact with?

A

Stomach and oesophagus

150
Q

What is the porta hepatis?

A

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
Q

What gives blood supply to the liver?

A

Hepatic portal vein

Common hepatic artery (branch of coeliac)

152
Q

When the common heptic artery reaches the porta hepatis, what does it do?

A

Divides into right and left branches then eventually to supply all 8 segments

153
Q

What % of blood reaching the liver does the hepatic artery deliver?

A

20%

154
Q

What drains the liver?

A

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
Q

What is the falciform ligament and what does it attach?

A

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
Q

Where is bile formed?

A

The liver

157
Q

Where does bile drain out the liver, where do they emerge?

A

Hepatic ducts, emerge from porta hepatis

158
Q

How does the liver join to the gall bladder?

A

Hepatic ducts merge into the common hepatic duct which drains into the gall bladder (via cystic duct)

159
Q

What is the role of the gall bladder?

A

Collects and temporarily stores bile

160
Q

How is bile conveyed to the duodenum?

A

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
Q

Approximately how long is the pancreas?

A

~15cm

162
Q

Is the pancreas retroperitoneal or intraperitoneal?

A

All retroperitoneal except the tail which is intraperitoneal

163
Q

What are the sections of the pancreas?

A

Head, with an uncinate process, a neck, a body and a tail.

164
Q

Where is the pancreas positioned on the posterior abdominal wall?

A

Slightly obliquely

165
Q

Where does the main pancreatic duct arise from and enter?

A

The tail, enters the duodenum at the postromedial wall

166
Q

What artery supplies the gall bladder?

A

Cystic artery

167
Q

What artery supplies the pancreas?

A

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
Q

True or false the pancreas receives blood supply from both the coeliac and SMA

A

True

169
Q

What structures pass through the porta hepatis?

A

Common hepatic duct, hepatic artery, hepatic portal vein

170
Q

What organ controls gall bladder contraction by endocrine mechanism?

A

Duodenum

171
Q

What function does the liver have in the embryo?

A

Haemopoietic function

172
Q

What are the functions of the large intestine?

A

Absorb water and store faeces before defacation

173
Q

What 3 factors allow large intestine to be distinguished from small intestine?

A

Taeniae coli
Haustrae
Epiploic appendicies

174
Q

When does smooth muscle of teniae coli terminate?

A

Rectum (S3)

175
Q

What are epiploic appendicies?

A

Fat filled pouches attached to colon

176
Q

What part of abdomen are caecum and appendix located?

A

Right iliac fossa

177
Q

Is the cecum intra or retroperitnoeal?

A

Intraperitoneal

178
Q

What is the widest part of the GI tract?

A

Caecum

179
Q

Blood supply to caecum?

A

Midgut so ileocilic artery from SMA which divides to anterior and posterior cecal artries

180
Q

How can appendix be distinguised from colon and caecum?

A

Lack of taeniae coli

Many lymphoid follicles

181
Q

What is mesoappendix and where does it span?

A

Short triangular shaped mesentery from mesentery of terminal ileum to appendix

182
Q

What does mesoappendix contain?

A

Appendicular vessels of ileocolic artery and vein

183
Q

Lymph from where drains to mesoappendix, where does it go from there?

A

Appendix and caecum to nodes in mesoappendix then ileocolic nodes

184
Q

Which plexus supplies the caecum and appendix?

A

Superior mesenteric plexus

185
Q

What happens to the pain location in appendicitis?

A

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
Q

What artery supplies appendix?

A

The SMA

Ileocolic artery

Appendicular artery

187
Q

Where is McBurney’s point?

A

1/3 the distance from anterior superior iliac spine to umbilicus

188
Q

Is the ascending colon intraperitoneal or retroperitoneal?

A

Retroperitoneal (only covered by peritoneum anteriorly)

189
Q

What is either side of ascending colon?

A

Paracolic gutters (spaces between colon and abdominal wall)

190
Q

Is transverse colon retroperitneal or intraperitoneal?

A

Intraperitoneal

191
Q

What is colon attached to at splenic flexure?

A

Phrenicocolic ligament

192
Q

Where is diaphragm attached to GI tract? how?

A

At splenic flexure, between transverse colon via phrenicocolic ligament

193
Q

What is mesocolon?

A

The part of the mesentery that attaches the colon to the abdominal wall.

194
Q

Is the descending colon intraperitoneal or retroperitoneal?

A

Retroperitoneal

195
Q

Where does descending colon extend to?

A

Sigmoid colon in left iliac fossa

196
Q

Describe course of sigmoid colon (e.g. from which compartment to which spinal level)?

A

Left iliac fossa to S3

197
Q

Is the sigmoid colon intraperitoneal or retroperitoneal?

A

Intraperitoneal

198
Q

How is sigmoid colon attached to posterior pelvic wall?

A

Sigmoid mesocolon

199
Q

What lies behind apex of sigmoid mesocolon?

A

Left Ureter as it crosses common iliac artery

200
Q

What supplies ascending colon?

A

Ileocolic artery and right colic

201
Q

What supplies transverse colon?

A

Right and middle colic, (from SMA) left colic (from IMA)

202
Q

What supplies descending colon?

A

Left colic artery

203
Q

What drains ascending colon?

A

Ilecolic and right colic veins into SMV

204
Q

What drains transverse colon?

A

Middle colic vein into SMV

205
Q

What drains descending colon?

A

Left colic vein into IMV

206
Q

What drains sigmoid colon?

A

Sigmoid veins into IMV

207
Q

Describe right side lymphatic drainage of colon

A

Inferior mesenteric noes to superior mesenteric and para aortic nodes

208
Q

Describe left side lymphatic drainage of colon

A

Directly into superior mesenteric nodes

209
Q

What do midgut structures receive sympathetic and sensory supply from?

A

Superior mesenteric plexus

210
Q

What provides symp supply to midgut?

A

T10-L2 via lumbar sympathetic chain and presacral nerves. .

211
Q

What plexus supplies hindgut?

A

Inferior mesenteirc plexus

212
Q

What is parasympathetic supply to hindgut?

A

Pelvic splanchnic nerve S2-S4

213
Q

What is sympathetic supply to hindgut?

A

Lumbar splanchnic nerve

214
Q

What is anterior to rectum?

A

Bladder, distal uterus, prostate, posterior vaginal wall

215
Q

What is posterior to rectum?

A

Sacrum, coccyx, lower sacral nerves

216
Q

What is the intersphinteric groove, what does it mark?

A

Indentation of anal canal (marks area between external and internal sphincters)

217
Q

What does dentate line mark (embryologically)?

A

Mucosa above dentate line endoderm, below is ectoderm

218
Q

What specific things does dentate line mark?

A

Where epithelium changes from columnar to stratified squamous

Superior rectal artery to middle+inferior rectal artery

Endoderm to ectoderm

219
Q

How do lymph and nerve supply vary across dentate line?

A

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
Q

What supplies rectum and upper anal canal above dentate line?

A

Superior rectal artery

221
Q

What supplies middle and inferior rectum, what does it branch from?

A

Middle rectal artery (branch of internal iliac)

222
Q

What supplies lower half of anal canal, what does it branch from?

A

Inferior rectal artery (branch of internal pudendal artery of internal iliac)

223
Q

Describe the anastomoses in rectal vasculature?

A

Anastomoses between branches of inferior mesenteirc and pudendal vessels

224
Q

What does superior rectal vein drain, which part of plexus?

A

Anal canal above dentate line

Superior part of internal and external plexus

225
Q

What does middle rectal vein drain, where does it drain into?

A

Middle part of external plexus into internal iliac

226
Q

What does inferior rectal vein drain, where does it drain into?

A

Inferior part of plexus

Drains into internal pudendal vein

227
Q

What do middle rectal veins anastomse with?

A

Superior and inferior rectal veins

228
Q

Describe parasympathetic, sympathetic and sensory supply to rectum

A

Para: pelvic splachnic nerve (S2-S4)

Symp: plexuses of coeliac and hypogastric nerve

Visceral afferent fibres follow para supply

229
Q

Describe lymph drainage of upper rectum

A

Lymph vessels follow superior rectal vein and drain to abdominal lymph nodes (para aortic)

230
Q

Describe lymph drainage of lower rectum

A

Inguinal nodes

231
Q

Describe upper anal canal lymph drainage

A

Internaliliac nodes

232
Q

Describe lower anal canal lymph drainage?

A

Inguinal nodes

233
Q

What vertebral level is the inferior horizontal part of the duodenum at?

A

L3

234
Q

What vertebral level is the superior duodenal flexure at?

A

L1

235
Q

What spinal level do visceral afferents from the ascending colon convey sensation to?

A

T10-T11 (umbilical)

236
Q

What produces colons sacculated (haustra) appearance?

A

Infoldings of the mucosal layer of the gut in this region

237
Q

Pathology in the sigmoid colon refers pain to which region?

A

Pubic

238
Q

What is the suspensory ligament of triez derived from?

A

Right diaphragmatic crus

239
Q

How far along the duodenum is the major papilla?

A

Mid-end of descending

240
Q

What type of retroperitoneal is ascending colon?

A

Secondarily

241
Q

What does the splenic artery give rise to?

A

Short gastric arteries and to the left gastroepiploic artery. (left greater curvature supply)

242
Q

What does the right gastroepiploic artery arise from?

A

Common hepatic artery

Gastroduodenal artery

243
Q

What region does the gall bladder lie in?

A

Epigastric

244
Q

The hepatic portal vein reaches the liver via the free margin of the…

A

Lesser omentum

245
Q

Blood from the liver drains to the…

A

IVC

246
Q

The head of the pancreas is lies in the…

A

Umbilical region

247
Q

The head of the pancreas surrounds the…

A

Superior mesenteric artery

248
Q

Tail of the pancreas extends towards the…

A

Spleen

249
Q

The free edge of the lesser omentum contains the

A

Portal triad of vessels (proper hepatic, common bile duct and portal vein)

250
Q

Large intestine features distinct from small intestine

A

Taenia coli
Haustrations
Appendices epiploicae

251
Q

Small intestine features distinct from large

A

Valvulae conniventes

Villi

252
Q

Appendicitis pain site

A

First periumbilical pain which then progresses to the right iliac fossa at Mc Burneys point (2/3 of way from umbilicus to ASIS)

253
Q

Where does the cystic artery arise from?

A

Common hepatic - right hepatic - cystic

254
Q

Relation of common bile duct to pancreas head

A

Posterior

255
Q

Tail of the pancreas passes through

A

Splenorenal ligament

256
Q

Calots triangle is formed by

A

Common hepatic duct, cystic duct and inferior edge of liver

257
Q

What does carlots triangle demarkate the position of ?

A

Cystic artery

258
Q

What liver ligament is a remnant of ventral mesentery in foetus?

A

Falciform

Gross anatomy (17 decks)

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