Gi tract and vessels Flashcards
the spleen gets its blood from?
celiac trunk-sneak
Where does the abdominal aorta begin?
At the aortic hiatus of the diaphragm-T12 and divides into common oliac arteries at L4
what level does the celiac trunk lie at?
T12
What level does the superior mesenteric lie at? Inferior?
L1, L3
What are the major branches of the celiac trunk?
left gastric, common hepatic, gastroduodenal artery
is the spleen derived from the foregut?
No but its celiac blood! INTRAPARTNEAL
What are the organs supplied by the celiac trunk?
Stomach Duodenum Liver Gall bladder Pancreas Spleen
What are the branches of the common hepatic artery?
gastroduodenal, hepatic artery, hepatic artery proper
The gastroduodenal artery supplies what
greater curvature of the stomach and the duodenum
The proper hepatic artery branches into what
R and L hepatic arteries which enter the liver at the porta hepatis
What are the branches of the gastroduodenal artery>
supraduodenal. superior pancreaticduodenal artery and right gastroomental
what is the blood supply to the pancreas?
SMA and celiac anastomosis
what are the branches of the splenic artery
L-gastromental, short gastric, pancreatic, splenic vein
what supplies the fundus of the stomach
short gastric arteries, from the splenic artery
What is the first part of the duodenum called?
deudenal bulb or ampulla
WHERE do most peptic ulcers occur?
80% in the duodenal bulb or CAP, 65% of ulcers in the duodenum are in the posterior wall.
What are peptic ulcers associated with?
H. pylor 90%
Whats a side effect of peptic ulcers?
perforation of the wall that will erode the pancreas or gastroduodenal artery causing massive hemorrhage
What are acquired hiatal hernias due to
weakening and eidening of the esophageal hiatus (T10)
What is the most common hiatal hernia? Whats it due to?
sliding, GERDthe gastroesphageal region slides superior into the thorax
What is the paresophageal hernia?
less common, pouch of peritoneam with the fundus extending into the hiatus anterior- NO GERD!
What are the major branches of the superior mesenteric?
Jejunal & Ileal Appendicular Ileocolic R colic Middle colic
What are the organs supplies by the SMA
Pancreas Duodenum Jejunum Ileum Cecum, appendix Ascending colon Hepatic flexure Proximal ⅓ of transverse colon
What is the path taken by the SMA to get to the mesentery?
btwn the neck and unicate process of the pancrease
What are the SMA branches to the small bowel?
inferior pancreaticoduodenal arteries, jejunal, ileal from the left side of the SMA
Whats the difference bwtn the branches of the SMA on the jejunum vs ileum
jejunum has longer vasa recta and bigger windows in the mesentery, ileum has shorter vasa recta and sometimes concentric arches of arteries withinthe mesentery
What are the branches of the right SMA
Ileocolic Appendicular Right Colic Middle Colic -most go to large bowel
what are some characteristics of the jejum?
prominant folds, mesentery next to it has no fat, long arteries
Characteristics of the ileum?
short straight arteries with lots of loops, fat, peyers patches,
what are the major branches of the IMA
L colic
Sigmoidal
Superior rectal
What organs are supplied by the IMA
Distal ⅔ of transverse colon
Descending colon
Sigmoid colon
Rectum
What are teniae coli of the colon
outer longitudinal muscle fibers, confied to 3 parallel bands- not a complete outer coat
What parts of the colon are secondarilty retroperitoneal
acedning and decending
what does the marginal artery represent?
anatomsis bwn SMA and IMA
What are the watershed areas of the colon?
splenic flexture, rectosigmoid junction, right colon
Appendicitis can result in?
necrosis and perforation, nacteria can evade the wall
Intital pain from a appendicitis is felt where/ THen goes where?
umbilicus T10, then moves to McBurneys point, 1/3 distance from the ASIS to the umbilicus, , lower right quandrant, rebound tenderness
How is a portal system defined>
arrangement of the vasculature whereby blood must pass through two sets of capillaries between the L ventricle and the R atrium.
Do the veins in the hepatic portal system have valves?
nope
Where deos venous drainage from the gut go first?
to the liver
what are the tributaries of the portal vein posterior to the neck of the pancreas?
Superior mesenteric vein
Splenic vein
Inferior mesenteric vein
Where is the hepatic portal vein found?
hepatoduodenal ligament (free edge of lesser omentum).
Portal HTN is an obstruction of what?
the portal vein, causes reversed blood flow into the systemic veins but blood can still reach RA via collateral routes
What makes up the esophageal varices?
the left gastric vein (portal) and azygos (systemetic) of veins in the gastroesophageal region
what results in the configuration of caput medusae
superior, inferior, and superficial brancehs of the epigastric veins and paraumbiical veins
What results in the rectal hemorrhoids or piles.
superior rectal vein (portal) middle and inferior rectal veins
What are clinical manifestations of portal HTN?
ascites, GI bleed, spelnomegaly, caput medusae
Where do the lymph nodes of the jejenum and ileum travel
within the folds of the mesentery toward the aorta and eventually to the cisterna chyli via the thoraic duct
LN follow the arteries, what artery in the upper portion of the rectum, what about the middle and lower part of the rectm?
superior rectal artery, inferior reactal artery branches of the external iliac
the cardiac orifice of the stomach is at what level?
T10, contains cardiac sphincter
The funcdus of the stomach is at?
5th intercostal space
what part of the duodenal is intraperitoneal?
the first part
What does the suspensory ligament (ligament of tritz) do?
suspends the 4th part of the duodenum from the rigth crus of the diaphgram, this part is just begining to be intraperitoneal
Where does the ielium end?
ileocecal juntion
Where does the jejum begin?
duodenaljejunal flexure
What state is the jejunum often in>
empty :(
