Gut Anatomy and Clinical Application Flashcards
1
Q
What is deglutination
A
- Complex movement involving skeletal and smooth muscle
2
Q
What are the 4 phases of swallowing
A
- Oral preparation
- Oral transit - voluntary
- Pharyngeal - involuntary
- Oesophageal - involuntary
3
Q
What nerves do the oral phase involve
A
CN V, VII, XI, X, XII
4
Q
Describe the 4 phases of swallowing
A
- Oral preparation - mastication of the food to form a food bolus
- Oral transit - voluntary - to back of oraopharyxi - tongue used to move bolus of food
- Pharyngeal - involuntary
- Oesophageal - involuntary
5
Q
How long is the oesophagus
A
25cm approximatley in length
6
Q
What are the three main parts of the oesphagus
A
Cervical
- cricopharyngeus to the throacic inlet (T4)
Thoracic
- Thoracic inlet to hiatus
Abdominal
- short segement before the gastro oesphageal junction
7
Q
What spinal level is the throacic inlet
A
T4
8
Q
Where does narrowing of the oesphagus happen
A
- Arch of the aorta
- left main bronchus
- diaphragmatic hiatus
9
Q
What three arterial vessels make up the oesopagus blood supply and what part of the oesphagus do they supply
A
Cervical oesophagus
- branches from the inferior thyroid artery
Thoracic oesophagus
- thoracic aortic branhces ( come of the aorta directly)
abdominal
- Coeliac plexus (from the left gastric artery)
10
Q
Describe the venous supply of the oesophagus
A
Cervical
- inferior thyroid veins - drain into the SVC eventually
thoracic
- azygous system
abdominal
- left gastric vein will drain into the portal system (site of portosystemic anastomose)
11
Q
Where does the oesphagus go through the diaphragm
A
T10
12
Q
what forms the oesophageal hiatus
A
- fibres from the right crux of the diaphragm
13
Q
What structures pass through the oesophageal hiatus
A
- Oesophagus
- vagus nerve
- left gastric vessels
- lymphatics frmo the lower third of the oesophagus
14
Q
Where is the aortic opening in the diaphragm
A
T12
15
Q
Where is the caval opening the diaphragm
A
T8
16
Q
what goes through the aortic opening and T12 in the diaphragm
A
- aorta
- thoracic duct
- azygous vein
17
Q
What goes through the caval opening at T8 in the diaphragm
A
- inferior vena cava
- right phrenic nerve
18
Q
what level does the vena cava go through the diaphragm
A
T8
19
Q
What type of sphincter is the oesophageal sphincter
A
- physiological sphincter
20
Q
What does the oesophageal sphincter do
A
Prevents reflux of food in the stomach
21
Q
what muscle is the oesophageal sphincter made out of
A
- Smooth muscle
22
Q
What are the symptoms of a hiatus hernia
A
- reflux
- bloating
- sore throat
- hoarse voice
- feeling of a lump stuck in the back of the throat
23
Q
what does oesphagitis lead to
A
Barrets oesophagus
24
Q
What are the types of hiatus hernia
A
- Sliding hiatal hernia - part of it slides up into the thorax
- paraoesphageal hiatal hernia - there is a herniated part of the stomach which reamins in the thorax
25
What is the more dangerous hiatal hernia
- paraoesphageal hiatal hernia
26
describe the arterial anatomy
- phrenic arteries
- coeliac trunk (T12) - splits into left gastric, common hepatic and splenic artery (also supplies pancreatic branches)
- superior mesenteric artery (L1)
- inferior mesenteric artery (L3)
laterally
- superrenal
- renal (L2)
inferior
- gonadal
27
What sections is the stomach made out of
- Fundus - passes superior to the level of the gastrooesphageal junction
- Cardia
- Body
- pylorus
28
What is the aterial supply of the stomach
- Left and right gastric pass along the lesser curvature of the stomach
- left and right gastro-epiploic pass on the great curvature of the stomach
- directly from the splenic artery there are short gastric arteries that supply the fundus of the stomach
29
```
where does the
- left gastric
- right gastric
- left gastro-epiploic
- right gastro-epiploic
originate from
```
- left gastric = coeliac trunk
- right gastric = hepatic artery
- left gastro-epiploic - splenic artery
- right gastro-epiploic - from the hepatic artery
30
What are the 4 parts of the duodenum
* 1st – Superior
* 2nd – Descending
* 3rd – Inferior
* 4th - Ascending
31
what parts of the duondeum are retroperiotneal
* 2nd – Descending
* 3rd – Inferior
* 4th - Ascending
32
describe the blood supply of the dudenum
- strong blood supply and branches are closely realted
- gastroduodenal artery from the right hepatic artery passes behind the 1st section
- this gives rise to the superior pancreaticduodenal artery
- there are recurrent branches from the inferior pancreaticduodenal artery from the superior mesenterci artery
33
blood supply from the duodenum also supplies the
- this blood supply also supplies the head of the pancreas
34
where does the bile duct enter
- major duodenal papilla
35
Describe how the gall bladder works
- left and right hepatic branches combine
- these form the common hepatic ducts
- the cystic duct from the gall bladder joints
- this forms the common bile duct
- the common bile duct goes into the pancreas
- pancreatic duct then joints just before the major duodneal papilla
- this then drains into the duodenum
36
describe the embrology of the abdomen
```
Fore gut
- celiac trunk
Mid gut
- superior mesenteric artery
Hind gut
- inferior mesenteric artery
```
37
What defines the section of the foregut
Mouth to the Major duodenal papilla (2nd part)
38
What defines the section of the midgut
2nd part duodenum to the 2/3 along transverse colon
39
What defines the section of the hundgut
2/3 along transverse colon to the Upper anal canal
40
where do foregut structures present with pain
Epigastric region
- pancreatitis
- gastritis
- billary colic
41
Where do midgut structures present with pain
Umbilicus reigon
- appendicits
- small bowel obstruction
42
Where do hind gut structures present with pain
Supa pubic region
- sigmoid diverticulitis
- colonic obstruction
43
If the abdomina pain is somatic what does it mean and what does it feel like
Peritoneum
- well localised
- stabbing/sharp
- mutiple nerve fibres
44
If the pain is visceral waht does it mean and what does it feel like
Organs
- dull
- difficult to differentiate
- less sensitive to direct trauma
- low density of innervation
- poorly localised
45
where do the blood vessels travel
- Mesentary
46
what branches makes up the superior mesenteric artery
- illeo-colic
- middle colic
- right colic
- marginal branches
- illeal branches
- jejunal branches
47
What branches make up the inferior mesenteric artery
- left colic
- sigmoid
- superior rectal
48
what is the watershed area
- area where the marginal arteriesa re
| - this is where the blood supply is often compromised
49
What happens if you lose blood supply to the proximal part of the superior mesenteric artery
- mesenteric ischaemia
50
What are the symptoms of mesenteric ischaemia
- sudden onset pain
- thromboembolic cause
- total blood supply loss
- severe pain
- management is operative
51
What happens if you loose blood supply to the more distal part in the mesenteric arteries
ischaemic colitis
52
what are the symptoms of ischaemic colitis
- hours onset
- cause is multifactoral
- transient blood supply loss
- symptoms include diarrhoea, PR bleeding, pain
- management is either conservative or operative
53
desscribe the rectal blood supply
Superior 1/3
- Superior rectal artery
- Inferior mesenteric artery
Middle 1/3
- Middle rectal artery
- Internal iliac artery
Inferior 1/3
- Inferior rectal artery
- Internal pudendal artery (iliac artery)
54
What is calots triangle
- Triangle between the inferior surface of the liver, cystic duct and common hepatic duct
55
What goes through calots triangle
Cystic artery - can cause significnat bleeding
56
Why do you look for calots triangle
- want to avoid clipping too low on the cystic duct and clipping onto the bile duct
57
which patients have oesophageal varices
- patients with portal hypertension
58
how does liver disease lead to bleeding varices
- A cirrhosised liver can cause an increase in resistance
- this casues an increase in hypertension
- this backs up along the left gastric vein which anatomises with the azygous vein
- due to the hypertension the blood no longer goes along the liver and instead passes along the left gastric vein to the azygous vein and drains through the vena cava
- this isnt desgined for this and the veins become stretched and dialted and oesphageal varices form
59
what are the 5 sites of porto systemic circulation
Lower 1/3 of oesophagus
- left gastric
- azygus
Umbilicus
- umbillical veins
- superior/inferior epigastric veins
Upper anal canal
- superior rectal vein
- middle/inferior rectal veins
Bare area of the liver
- hepatic/portal veins
- inferior phrenic veins
retroperiotneum
60
What causes caput medusae
- Anastomoses of the superficial veins of the abdominal wall with the ligamentum teres
61
What artery passes posteriorly to the duodenum
- gastroduodenal - ulcers are common in the duodenum and if they perforate posteriorly into the duodenum then they can cause gastroduodenal bleeding
62
Name the symptoms, imaging and management for someone with anterior and posterior duodneal ulcers
Anterior
- Pain - release gastric contents
- pneumoperitoneum imaging
- operative management
posterior
- pain and bleeding
- normal on imaging
- management - endoscopic, IR, operative
63
What is acute cholecystitis
- stone becomes impacted in hartmanns pouch
- gallbladder can become inflammated
- can become infected by a bacterial secondary infection
64
What is the pain like in billary colic
- pain after eating
| - pain radiates to the back due to referred pain from the midgut
65
How does cholecystitis develop (in hartmanns pouch)
- Billary colic where the stone blocks the cystic duct
- this if the obstruction becomes infected can form a mucocele (obstruction infection)
if there is a simple infection of the gall bladder it is called a cholecystitis
66
How does cholangitis develop develop in
- there is an obstruction in the billary duct
- this causes obstructive jaundice
- this leds to cholangitis
67
asymptomatic gallstones should not be..
treated
68
Describe the pain of chronic cholelithiasis
- recurrent biliary pain usually less than 3 hours
69
describe the pain of acute cholecystitis
- Sharp to dull biliary pain usually greater than 6 hours
- fever
- murphy's sign
- nausea
- vomitting
70
describe the pain of choledocholithiasis
- abdominal pain in the upper or middle right upper abdominal quadrant
- billary pain
- fever
- jaundice
- loss of appetite
- nausea and vomitting
71
describe the pain of cholangitis
biliary pain
- fever
- jaundice
- chills
- clay-coloured stools
- dark urine
- nausea adn vomitting
72
What is charcots triad
- sign used for cholangitis
73
What three symptoms make up charcots triad
- Jaundice
- RUQ pain
- Fever / Rigors
74
What makes up reynolds pentad (cholangitis)
- Jaundice
- RUQ pain
- Fever / Rigors
- confusion
- hypotension
75
describe the pain in appendicitis
Migratory RIF pain - starts in the umbilicus and localises
76
What can cause appendicitis
Obstruction of an appendix
- lymphangitis
- appendicolith
- foreign body
- worms
77
What can cause increased pressure in the appendix wall
- venous stasis
- thrombosis
- lymphatic obstruction
- swelling
78
What are the borders of calot's triangles
- cystic artery
- cystic duct
- hepatic duct
