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MET3a > Gut Anatomy & Clinical Applications > Flashcards

Gut Anatomy & Clinical Applications Flashcards

1
Q

4 phases of swallowing

A

Oral preparation (mastication)
Oral transit - voluntary, tongue moves bolus posteriorly
Pharyngeal - involuntary
oesophageal - involuntary, sphincters

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2
Q

Define deglutination

A

Swallowing
Skeletal and SM
Complex movement

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3
Q

Cranial nerves involved in swallowing

A 
V - trigeminal
VII - facial
X - vagus
IX - glossopharyngeal
XII - hypoglossal
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4
Q

Parts of oesophagus

A
  • cervical (cricopharyngeus to thoracic inlet)
  • thoracic (to hiatus)
  • abdominal (to gastro-oesophageal junction)
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5
Q

How long is the oesophagus?

A

Approx 25cm

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6
Q

3 normal narrowings of oesophagus where large objects can get stuck

A
  • cervical constriction = cricoid cartilage
  • thoracic constriction = aortic arch & L main bronchus
  • diaphragmatic constriction = diaphragmatic hiatus
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7
Q

Blood supply to oesophagus

A
  • cervical = inferior thyroid from subclavian
  • thoracic = aorta
  • abdominal = coeliac plexus from L gastric artery
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8
Q

Venous supply of oesophagus

A
  • cervical to inferior thyroid veins to SVC
  • thoracic to azygous system
  • abdominal to left gastric vein via portal system

(porto-systemic anastomoses)

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9
Q

Oesophageal hiatus

A

T10
Right crux of diaphragm fibres
Left side of median plane
Oesophagus, L. gastric vessels, lymphatics from oesophagus lower 1/3 and vagus nerve pass through

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10
Q

Aortic hiatus

A

T12
Median plane
Aorta, thoracic duct and azygos vein pass through

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11
Q

Vena cava hiatus

A

T8
Right side of median plane
IVC and right phrenic nerve pass through

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12
Q

Oesophageal sphincter

A

Physiological
SM of oesophagus
Skeletal muscle of crural diaphragm
Prevents of reflux of food from the stomach

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13
Q

Hiatus hernia how?

A

No formal sphincter just physiological

Oesophageal sphincter becomes dilated

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14
Q

Hiatus hernia symptoms

A 
Reflux
Bloating
Sore throat
Hoarse voice
(globus sensation)
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15
Q

Sliding hiatus hernia

A

Part of stomach rises directly through hiatus

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16
Q

Paraesophageal hiatus hernia (rolling)

A

Part of stomach folds up onto oesophagus and herniates through diaphragm
Much more dangerous
Can become strangulated = need emergency surgery

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17
Q

Where do the phrenic arteries pass?

A

Underneath the diaphragm

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18
Q

Branches of the celiac trunk

A

L gastric
Common hepatic artery
Splenic artery

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19
Q

Abdominal aorta branches

A 
First phrenic arteries
Then celiac trunk
Then SMA = small bowel
IMA = left colon and superior rectum
Renal arteries
Gonadal arteries
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20
Q

Which branches pass anteriorly to the oesophagus

A

Celiac trunk
SMA
IMA

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21
Q

What branches pass laterally to the oesophagus?

A

Renal arteries
Gonadal arteries

Retroperitoneal unlike anterior branches which pass into peritoneum

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22
Q

Anatomy of stomach

A 
Abdominal oesophagus
Cardiac sphincter
Fundus
Cardia
Body
Lesser and greater curve
Antrum
Pylorus
Pyloric sphincter
Duodenum
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23
Q

Arterial supply of stomach

A

L gastric artery = lesser curve up to oesophagus
R gastric artery is branch of hepatic artery = lesser curve to anastomose with L gastric artery
Right gastroepiploic artery from hepatic artery = greater curve
Left gastroepiploic artery from splenic = greater curve
Short gastric arteries from splenic = fundus of stomach

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24
Q

4 parts of the duodenum

A

Superior
Descending
Inferior
Ascending

In that order

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25
Which parts of the duodenum are retroperitoneal?
2nd to 4th Descending, inferior, ascending All expect for superior
26
Blood supply of duodenum
Gastroduodenal from R hepatic artery behind first section of duodenum and gives rise to superior pancreaticoduodenal arteries Inferior pancreaticoduodenal artery from SMA All also supplies pancreas
27
Where is the duodenal papilla?
Medial part of 2nd part (descending part) of duodenum Where common bile duct empties and pancreatic duct empties Retroperitoneal
28
Bile tree
R and L hepatic ducts join to form hepatic duct Cystic duct from gall bladder joins with hepatic duct forming common bile duct Common bile joins with pancreatic duct emptying into major duodenal papilla Sometimes there is an accessory pancreatic duct which will empty into a minor duodenal papilla
29
Hepatopancreatic ampulla
Common bile duct and pancreatic duct combining
30
Where is bile produced?
Liver | Stored in the bile duct
31
Embryological blood supply of gut
Foregut = celiac trunk Mid gut = SMA Hind gut = IMA
32
Foregut
Stomach to 2nd part of duodenum
33
Mid gut
3rd part of duodenum to 2/3 of transverse colon
34
Hind gut
Rest of colon to superior rectum
35
Visceral innervation
Visceral = dull pain, not well localised, referred pain Less sensitive to direct trauma Low density of innervation
36
Foregut Injury pain referred where? and examples
``` Pain in epigastrium Cholecystitis Pancreatitis Gastritis Biliary colic ```
37
Midgut injury pain referred where? and examples
Umbilicus Appendicitis Small bowel obstruction
38
Hindgut injury pain referred where? and examples
Suprapubic region Sigmoid diverticulitis Colonic obstruction
39
Somatic innervation
Well localised sensation Stabbing/sharp Multiple nerve fibres
40
Ileocolic branch
From SMA | Terminal ileum and cecum
41
What supplies the midgut colon?
SMA = ileocolic branch, right and middle colic arteries
42
What supplies the hindgut?
IMA = left colic artery, sigmoid artery to superior rectal | Middle and inferior rectal arteries come from external iliac artery
43
Watershed area
``` Crossover between SMA and IMA Marginal artery Splenic flexure Susceptible to colonic ischaemia Consider during colorectal surgery - do not perform anastomoses in this area ```
44
Mesenteric ischaemia (important to distinguish with ischaemia colitis!!)
``` SMA proximal problem Sudden Thromboembolic cause Total blood loss Severe pain Operative Tx ```
45
Ischaemic colitis (important to distinguish with mesenteric ischaemia!!)
``` SMA More distal problem Hourly onset Multi causes Transient blood loss as collateralisation of blood supply Diarrhoea, PR bleeding ,pain Conservation/operative Tx ```
46
Rectal blood supply
``` Superior = IMA - superior rectal artery Middle = internal iliac - middle rectal Inferior = internal iliac - internal pudendal - inferior rectal ```
47
Calot's triangle
``` Cystic duct Common hepatic duct Inferior surface of liver Cystic artery runs in triangle Clipping on cystic duct but not too low that you clip on common bile duct ```
48
Oesophageal varices Cause
Liver cirrhosis = increase in vascular resistance Portal HTN as increased hepatic resistance, decreased hepatic outflow and splanchnic arterial vasodilation (more inflow) Varices as dilation of vessels in oesophagus and stomach Increase in size with severity of portal HTN and can rupture/bleed when pressure exceeds a maximal point Azygos blood flow instead which is not used to high pressure flow
49
Porto-systemic circulation sites
Lower 1/3 of oesophagus (L gastric meets azygos) Umbilicus (umbilical meets superior/inferior epigastric veins)-> caput medusae Upper anal canal (superior rectal vein meets middle/inferior rectal veins) -> anal varices Bare area of liver (hepatic/portal veins meet inferior phrenic vein)
50
Duodenal artery route
Posteriorly to duodenum Ulcers perforate posteriorly into artery = bleeding Anterior perforation = into peritoneal cavity as first part of duodenum is intraperitoneal= free air = seen on CXR
51
Anterior Duodenal ulcers
Pain Pneumoperitoneum imaging Operative management
52
Posterior duodenal ulcers
Pain & bleeding Normal imaging Endoscopy/operative Tx
53
Ischaemic Bowel
Total or segmental
54
Acute cholecystitis
Stone impacted in Hartmann's pouch = can cause oedema, infection Peritonism if stone irritates peritoneum Initially sterile Secondary infection
55
Gall Bladder Disease Stages/types
Biliary colic = gall bladder not inflamed, stone impacting hartmann's pouch = pain, after eating, radiates to back as referred from midgut, with heavy meals Stone impacted in gall bladder neck, mucus from gall bladder lining cannot escape, mucus seal causes pain, if infected = cholecystitis, repeated bouts = gall bladder inflamed and fibrous Stones escape out of pouch into common bile duct = obstructed = jaundice, if infected = cholangitis, life threatening, sepsis risk
56
2 ways to recognise cholangitis
Charcot's triad | Reynold's pentad
57
Charcot's triad
Jaundice RUQ pain Fever/rigors Cholangitis
58
Reynold's pentad
Charcot's triad | + confusion and hypotension
59
Appendicitis
Midgut pain Migratory RIF Inflammation to anterior abdominal wall = more localised pain
60
Causes of appendicitis
Obstruction to appendix - lymphangitis - appendiclolith - foreign body - worms
61
Mechanism of appendicitis
Increased pressure in appendix wall = - venous stasis - thrombosis - lymphatic obstruction - swelling

MET3a (38 decks)

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