GI Tract: Mouth, Esophagus, Stomach, Duodenum Flashcards
What is the position of the cardia?
The fundus?
Pylorus?
Cardia - Th11
Fundus - beneath left dome of diaphragm
Pylorus - 2 cm from midline @ L1
What is the important anatomical cross-section which passes through the stomach?
Where is it in relation to the sternum and pelvis?
Bonus: what important structures does it pass through?
Transpyloric Plane
- halfway between the jugular notch and pubic symphysis
Passes through:
- pylorus
- L1
- gallbladder fundus
- pancreas (body)
- sup. mesenteric A/V (origin/termination)
- colic flexures
- L renal hilum
- transverse mesocolon root
- duodenojejunal flexure
- superior horizontal duodenum
- cisterna chyli
*
What are the 3 muscle layers of the stomach?
One of them is not in the whole stomach… which and where is it?
Outer Longitudinal
Middle Circular
Inner Oblique - only from cardia to angular notch
What are the longitudinal ridges of the gastric mucosa called?
2 names
What do they form which directs food towards the pyloric part of the stomach?
**Gastric Rugae **or Folds
- form the Gastric Canals or Magan Strasse during swallowing
What are the 3 clinically important parts of the stomach according to its contact with other organs?
- Facies Libera - a “free” anterior portion not covered by ribs or liver
- Facies Diaphragmatica - AKA Traube’s Space, covered by the left ribs and sitting under the left diaphragmatic dome
- Facies Hepatica - mostly cardia/fundus covered by left lobe of liver, a bit of superior body/pylorus too
What are the divisions of the celiac trunk?
And the name for all three together?
Haller’s Tripod
(L to R)
- Common Hepatic Artery
- Splenic Artery
- Left Gastric Artery
What are the branches of the splenic artery?
Short Gastric Arteries
Left Gastro-omental Artery
Posterior Gastric Artery
Pancreatic Arteries
What are the branches of the common hepatic artery?
List them in order from its origin.
- Gastroduodenal Artery
- Proper Hepatic (continuation after gastroduod.)
- Right Gastric Artery (may be before gastroduod.)
What are the branches of the gastroduodenal artery?
Right Gastro-omental
Superior Pancreaticoduodenal
What vein drains the superior portion of the lesser curvature of the stomach?
Two names.
Where does it drain to?
**Coronary Vein **or Left Gastric Vein
- drains to Portal Vein
What are the important lymph nodes of the stomach?
- Paracardial (angle of His)
- Inferior (greater curvature under pylorus)
- Superior (lesser curvature)
- Subpyloric (just under pyloric sphincter)
just remember… PISS
Describe the peritoneal relations of the duodenum’s different parts.
- Superior Horizontal - intraperitoneal (AKA duod. bulb)
- Descending - retroperitoneal
- Inferior Horizontal - retroperitoneal
- Ascending - retroperitoneal
- Duodenojejunal Flexure - intraperitoneal again
Describe the 3 main peritoneal folds/recesses relevant to the duodenum.
What is their clinical significance?
- Superior Duodenal Fold/Recess - from duodenojejunal flexure leftward
- Inferior Duodenal Fold/Recess - from inferior end of ascending part leftward
- Paraduodenal Fold/Recess - (Landzert’s Fossa) - sometimes between DJ flexure and left kidney, containing left colic a. + inf. mesenteric v.
- clinically… sites of Treitz Hernias
What are the entrances for digestive juices into the duodenum?
Which ducts empty into them?
-
Major Duodenal Papilla (Vater’s)
- Common Bile Duct
- Main Pancreatic Duct (Wirsung’s)
- guarded by Sphincter of Oddi
-
Minor Duodenal Papilla (Schner or Santorini’s)
- Accessory Pancreatic Duct (Santorini’s)
Which vessels are in close proximity to the inferior horizontal part of the duodenum and why is this significant?
Superior Mesenteric Artery and Aorta
- can compress an overfilled duodenum after a large meal, causing ileus, or bowel obstruction
What vessels supply the duodenum and head of pancreas?
How are they significant embryologically?
- Common Hepatic A. > Gastroduodenal A. (sup. horiz. part)
- Gastroduodenal A. > Superior Pancreaticoduodenal A. > Ant./Post. Branches
- Superior Mesenteric A. > Inferior Pancreaticoduodenal A. > Ant./Post. Branches
- Lesser Riolan Anastomosis/Arch between branches of both pancreaticoduodenal arteries is the embryological border between fore-/midgut
How is venous blood drained from the duodenum (and head of pancreas) ?
Pancreaticoduodenal Veins > Superior Mesenteric Vein > Portal Vein
What are the circular ridges of mucosa within the duodenum?
Folds of Kerckring
What is found along the medial wall of the descending part of the duodenum above/below the major duodenal papilla?
Longitudinal Fold(s) of mucosa
What innervates the duodenum?
Parasympathetic: Vagus N.
Sympathetic: Lesser/Greater Splanchnic Ns.
How is lymph drained from the duodenum?
anterior vessels > ** Pancreaticoduodenal / Pyloric Nodes**
posterior vessels > Superior Mesenteric Nodes
What is the blood supply of the palatine tonsil?
- Ascending Palatine A. < Facial A. < ECA
- Descending Palatine A. < Maxillary A. < ECA
- Ascending Pharyngeal A. < ECA
- Lingual A. < ECA
What are the roof and floor of the isthmus of the fauces?
roof - soft palate + muscle aponeurosis
floor - follicular part of tongue + lingual tonsil
What is the motor innervation for the tongues muscles?
CN XII Hypoglossal Nerve
