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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
Q

Which parts of the duodenum are retroperitoneal?

A

2nd to 4th
Descending, inferior, ascending

All expect for superior

26
Q

Blood supply of duodenum

A

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
Q

Where is the duodenal papilla?

A

Medial part of 2nd part (descending part) of duodenum
Where common bile duct empties and pancreatic duct empties
Retroperitoneal

28
Q

Bile tree

A

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
Q

Hepatopancreatic ampulla

A

Common bile duct and pancreatic duct combining

30
Q

Where is bile produced?

A

Liver

Stored in the bile duct

31
Q

Embryological blood supply of gut

A

Foregut = celiac trunk
Mid gut = SMA
Hind gut = IMA

32
Q

Foregut

A

Stomach to 2nd part of duodenum

33
Q

Mid gut

A

3rd part of duodenum to 2/3 of transverse colon

34
Q

Hind gut

A

Rest of colon to superior rectum

35
Q

Visceral innervation

A

Visceral = dull pain, not well localised, referred pain
Less sensitive to direct trauma
Low density of innervation

36
Q

Foregut Injury pain referred where? and examples

A 
Pain in epigastrium
Cholecystitis
Pancreatitis
Gastritis
Biliary colic
37
Q

Midgut injury pain referred where? and examples

A

Umbilicus
Appendicitis
Small bowel obstruction

38
Q

Hindgut injury pain referred where? and examples

A

Suprapubic region
Sigmoid diverticulitis
Colonic obstruction

39
Q

Somatic innervation

A

Well localised sensation
Stabbing/sharp
Multiple nerve fibres

40
Q

Ileocolic branch

A

From SMA

Terminal ileum and cecum

41
Q

What supplies the midgut colon?

A

SMA = ileocolic branch, right and middle colic arteries

42
Q

What supplies the hindgut?

A

IMA = left colic artery, sigmoid artery to superior rectal

Middle and inferior rectal arteries come from external iliac artery

43
Q

Watershed area

A 
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
Q

Mesenteric ischaemia (important to distinguish with ischaemia colitis!!)

A 
SMA proximal problem 
Sudden
Thromboembolic cause
Total blood loss
Severe pain
Operative Tx
45
Q

Ischaemic colitis (important to distinguish with mesenteric ischaemia!!)

A 
SMA More distal problem
Hourly onset
Multi causes
Transient blood loss as collateralisation of blood supply
Diarrhoea, PR bleeding ,pain
Conservation/operative Tx
46
Q

Rectal blood supply

A 
Superior = IMA - superior rectal artery
Middle = internal iliac - middle rectal
Inferior = internal iliac - internal pudendal - inferior rectal
47
Q

Calot’s triangle

A 
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
Q

Oesophageal varices Cause

A

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
Q

Porto-systemic circulation sites

A

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
Q

Duodenal artery route

A

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
Q

Anterior Duodenal ulcers

A

Pain
Pneumoperitoneum imaging
Operative management

52
Q

Posterior duodenal ulcers

A

Pain & bleeding
Normal imaging
Endoscopy/operative Tx

53
Q

Ischaemic Bowel

A

Total or segmental

54
Q

Acute cholecystitis

A

Stone impacted in Hartmann’s pouch = can cause oedema, infection
Peritonism if stone irritates peritoneum
Initially sterile
Secondary infection

55
Q

Gall Bladder Disease Stages/types

A

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
Q

2 ways to recognise cholangitis

A

Charcot’s triad

Reynold’s pentad

57
Q

Charcot’s triad

A

Jaundice
RUQ pain
Fever/rigors

Cholangitis

58
Q

Reynold’s pentad

A

Charcot’s triad

+ confusion and hypotension

59
Q

Appendicitis

A

Midgut pain
Migratory RIF
Inflammation to anterior abdominal wall = more localised pain

60
Q

Causes of appendicitis

A

Obstruction to appendix

  • lymphangitis
  • appendiclolith
  • foreign body
  • worms
61
Q

Mechanism of appendicitis

A

Increased pressure in appendix wall =

  • venous stasis
  • thrombosis
  • lymphatic obstruction
  • swelling

MET3a (38 decks)

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