GIT-Peritoneal cavity, pancreas and small intestine

Question 1

Where is pus accumulated in conditions like gallbladder infection and pancreatitis?

Answer 1

Peritoneal space

Question 2

Where is the lesser sac located? (Posterior, Superior, Inferior )

Answer 2

• Lies posterior to the stomach and the lesser omentum
• Superiorly bounded by the diaphragm
• Inferiorly bounded by the layers of greater omentum
• Communicates with the greater sac through the omental foramen
• Its left margin is formed by the spleen

lesser sac is a cavity while lesser omentum is a connective tissue structure

Question 3

What is another name for lesser sac of the pritoneal cavity?

Answer 3

Omental Bursa

Question 4

What is the main part of the peritoneal cavity?

Answer 4

Greater sac

Question 5

____ devides the greater sac into ____ compartment and ____ compartment

Answer 5

Transverse mesocolon devides the greater sac into **supracolic compartment ** and infracolic compartment

Question 6

What does the supracolic compartment consists of?

Answer 6

Stomach, liver and spleen

Question 7

What does th infracolic compartment consits of?

Answer 7

Small intestine and colon

Question 8

____ lie on the lateral sides of the ascending and descending colons
Right ____ communicates with right subhepatic space
Left ____ communicates is seperated from the diaphragm by the ______

Answer 8

Paracolic gutters lie on the lateral sides of the ascending and descending colons
Right paracolic gutter communicates with right subhepatic space
**Left paracolic gutter ** is seperated from the diaphragm by the **phrenicocolic ligament **

Right: It communicates with the hepatorenal recess and the pelvic cavity. It provides a route for the spread of infection between the pelvic and the upper abdominal pain

Left: It is a fold of perotoneum that passes from the colic flexure to the diaphragm

Question 9

What type of jaundice does cancer of the head of the pancrease cause?

Answer 9

Obstructive jaundice

Question 10

Is pancreas retroperitoneal or interaperitoneal?

Answer 10

Retroperitoneal

Question 11

Pancreas:
- Lies between the ____ on the ____ and ____ on the ____
- Head, neck, body, ____ and ____
- Root of the transverse mesoclon lies along the anterior margin

Answer 11

Pancreas:
- Lies between the duodenum on the right and spleen on the ** left**
- Head, neck, body, neck and uncinate process
- Root of the transverse mesoclon lies along the anterior margin

Question 12

Which cancer has a better prognosis? Cancer at the tail of pancreas or cancer at the head of pancrea?

Answer 12

Cancer at the tail of pancreas has a better prognosis as head is nearer to the bile duct

Question 13

Pancreatic Ducts:
Main pancreatic duct open into the ____. Accessory pancreatic duct opens into the ____

Answer 13

Pancreatic Ducts:
Main pancreatic duct open into the ampulla of vater. Accessory pancreatic duct opens into the duodenum

Question 14

The pancreas produces exocrine secretion that enters the ____ and endocrine secretions that enter the ___

Answer 14

The pancreas produces exocrine secretion that enters the duodenum and endocrine secretions that enter the blood

mainly glucagon and insulin

Question 15

Head of pancreas:
Attached to the ____ part of the ____, ____ lies posteriorly

Answer 15

Atrtached to the descending part of the duodenum **common bile duct **lies posteriorly

Question 16

Neck of pancreas:
____ vessels and ____ vein posteriorly

Answer 16

Superior mesenteric vessels and **splenic vein ** posteriorly

Question 17

Body of pancreas:
- Forms the floor of the ____
- ____ anteriorly
- ____ posteriorly

Answer 17

• Forms the floor of the omental bursa (Lesser sac)
• Stomach anteriorly
• Left kidney posteriorly

Question 18

Tail of pancreas:
Related to the ____ of the ____

Answer 18

Related to the hilum of the spleen

Question 19

Uncinate process:
____ vessels lie in front (But the lie behind the neck of the pancreas)

Answer 19

Superior mesentrice vessels

Question 20

Arterial supply:
Head:
- Branches of the ____ and superior mesentric artries via superior ____ arteries and inferior ____

Neck, Body and Tail:

• Branches of the ____ arteries

Answer 20

Arterial supply:
Head:
- Branches of the gastroduodenal and superior mesentric artries via superior **pancreatico duodenal ** arteries and inferior pancreatico duodenal arteries

Neck, Body and Tail:

• Branches of the** splenic** arteries

Question 21

Where does the pancreas drain to? (venous)

Answer 21

Splenic vein and portal vein

Question 22

Sympathetic innervation of the pancreas:
- ____ pancreatic secretions

Parasympathetic innervation of the pancreas:
- ____ pancreatic secretion

Answer 22

Sympathetic innervation of the pancreas:
- ** Decrease** pancreatic secretions

Parasympathetic innervation of the pancreas:
- Increase pancreatic secretion

Question 23

What is Pancreatitis associated with?

Answer 23

Alcoholism

Question 24

What are the four portal-systemic anastomoses?

Answer 24

Oesophagus
Rectum
Umbilicus
Posterior abdominal walls

Haemorrhage is common in oesophagus and rectum

Question 25

How does cancer of the head of the pancreas give rise to obstructive jaundice?

Answer 25

Common bile duct lies behind the head of pancreas. Hence, a cancerous mass in the head of pancreas can compress the bile duct (obstruction) giving rise to obstructive jaundice.

Question 26

Where is a major site of digestion and absorption?

Answer 26

Small Intestines

Question 27

Small Intestine: - Extends from the ____ of the somach to the ____ - Major part of the digestion and absorption tkes place in the small intestine - Divided into duodenum, ____ and ____

Answer 27

Small Intestine: - Extends from the ** pylorus **of the somach to the **ileocecal junction** - Major part of the digestion and absorption tkes place in the small intestine - Divided into duodenum, **jejunum** and **ileum**

Question 28

Duodenum (IMPT): - 10 inches long, divided into superior, descending, inferior and ascending part - ____ part of the duodenum = duodenal cap - ____ part of the duodenum contains entrance for ____ (Major Duodenal Papilla) - Most of the duodenum is ____

Answer 28

Duodenum: - 10 inches long, divided into superior, descending, inferior and ascending part - ** First** part of the duodenum = duodenal cap - **Second **part of the duodenum contains entrance for **common bile duct** (Major Duodenal Papilla) - Most of the duodenum is **retroperitoneal**

Question 29

Duodenum (IMPT): 1(Superior part): 5cm long, L1 level 2(Descending): 7-10cm long, L1-L3 3(Inferior): 6-8cm, crosses L3 4(Ascending): ____

Answer 29

Duodenum (IMPT): 1(Superior part): 5cm long, L1 level 2(Descending): 7-10cm long, L1-L3 3(Inferior): 6-8cm, crosses L3 4(Ascending): 5cm, to L2

Question 30

Duodenum (IMPT): * Supplied by the branches of ____ trunk and ____ artery * Superior pancreatico duodenal artery (indirectly from celiac): Supplies the part above the entry of ____ * Inferior pancreatico duodenal artery (a direct branch of superior mesentric artery): Supplies the part ____ to the ____ of bile duct * Both ____ and ____ anastomose * ____ veins drain into the ____ vein * Innervated by the ____ nerves from the ____ and ____ plexus and parasympathetic (vagus)

Answer 30

Duodenum (IMPT): * Supplied by the branches of **celiac ** trunk and **superior mesentric artery** * Superior pancreatico duodenal artery (indirectly from celiac): Supplies the part above the entry of **bile duct** * Inferior pancreatico duodenal artery (a direct branch of superior mesentric artery): Supplies the part **distal** to the **entry** of bile duct * Both **superior ** and **inferior pancreatico duodenal arteies** anastomose * **Duodenal** veins drain into the **portal** vein * Innervated by the **sympathetic** nerves from the **celiac** and **superior mesentric plexus** and parasympathetic (vagus)

Question 31

Duodenal ulcers occurs most commonly om which part of the duodenum?

Answer 31

1st part: Superior part ## Footnote Anteriorly/ posteriorly

Question 32

Anterior duodenal ulcer eroudes ____ causing ____ Posterior duodenal ulcer erodes either ____ or ____ causing ____

Answer 32

Anterior duodenal ulcer eroudes **peritoneum** causing **peritonitis** ​ Posterior duodenal ulcer erodes either **gastroduodenal artery** or **posterior superior pancreaticoduodenal artery** causing **hemorrhage**

Question 33

What is the junction between the duodenum and jejunum called?

Answer 33

Duodeno jejunal junction

Question 34

What is the junction between ileum and caecum called?

Answer 34

Ileocaecal junction

Question 35

Are jejunem and ileum retroperitoneal?

Answer 35

No, they are entirely intraperitoneal

Question 36

Jejunem and Ileum: - Length 20 feet approximately - Upper 2/5 jejunem rest ileum - Jejunem loops ____ quadrant - Ileum loops ____ quadrant

Answer 36

Jejunem and Ileum: - Length 20 feet approximately - Upper 2/5 jejunem rest ileum - Jejunem loops **left upper quadrant** - Ileum loops **right lower quadrant**

Question 37

Jejunem and Ileum (morphology): - ____ mesentry with long free edge and a short root - Mucosa: ___ folds - ___ frequent in terminal ileum

Answer 37

Jejunem and Ileum (morphology): - **Fan shaped** mesentry with long free edge and a short root - Mucosa: **Circular** folds **plicae circulares** - **Peyer's patches (lymphoid tissue)** frequent in terminal ileum

Question 38

What morphologic features suggests the terminal ileum?

Answer 38

Peyer's patches

Question 39

What are the difference between jejunem and ileum?

Answer 39

Jejunem: - Proximal two-fifths - Wide-bored and thick walled. Closely arranged plicae. inside - Less prominent arterial arcades - Longer vasa recta Ileum: - Distal three-fifths - Smaller in diameter and thinner walls - Prominent arterial arcades - shorter vasa recta

Question 40

Jejunum and Ileum: -Arterial supply from the ____ artery - ____ drains the venous blood from the jejunem and ileum into the ____ vein - ____ vein joins with ____ vein to form the ____ vein

Answer 40

Jejunum and Ileum: -Arterial supply from the **superior mesentric artery (SMA)** - **SMV** drains the venous blood from the jejunem and ileum into the **portal vein** - **SMV** vein joins with **splenic** vein to form the **portal** vein

Question 41

Nerve supply to small intestine: - The small intestine is supplied by autonomic (sympathetic and parasympathetic) and sensory fibers in the ____ and ____ - Sympathetic fibers (____): reduce bowel motility, reduce intestinal secretions, causes vasoconstriction - Parasympathetic nerve fibres (Vagus): Increase bowel motility, stimulate intestinal secretions, causes vasodilation - The sensory fibers are sensitive to ____ and ____

Answer 41

Nerve supply to small intestine: - The small intestine is supplied by autonomic (sympathetic and parasympathetic) and sensory fibers in the **celiac** and **superior mesenteric plexus** - Sympathetic fibers **(greater splanchnic)**: reduce bowel motility, reduce intestinal secretions, causes vasoconstriction - Parasympathetic nerve fibres (Vagus): Increase bowel motility, stimulate intestinal secretions, causes vasodilation - The sensory fibers are sensitive to **distension** and **nociceptive pain**

Question 42

Lympatics vessels of jejunem and ileum: - Lympatic vessels from the walls of jejunem and ileum drain into ____ (found btwn the layers of mesentry) - ____ lympatic vessels from the ____ nodes drain into the superior mesentric nodes (found around the origin of SMA)

Answer 42

Lympatics vessels of jejunem and ileum: - Lympatic vessels from the walls of jejunem and ileum drain into **mesentric lymph nodes** (found btwn the layers of mesentry) - **Efferent** lympatic vessels from the **mesentric** nodes drain into the **superior mesentric nodes** (found around the origin of SMA)

Question 43

Where does the upper digestive system end?

Answer 43

Beginning of the duodenum