Gut and Blood Supply Flashcards by Libby Halligan

Coeliac Trunk divides into and supplies

left gastric
splenic
common hepatic
“foregut”

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What are the spinal levels of the coeliac trunk, SMA and IMA?

Coeliac trunk= T12
SMA= L1
IMA= L3

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Blood supply to the pancreas?

From both Coeliac trunk AND SMA

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Component viscera of Foregut?

oesophagus
stomach
Liver
proximal 1/2 duodenum 
*pancreas

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Neurovascular supply and lymphatics to Foregut?

Arterial: branches off coeliac axis (abd. aorta @ T12)
Venous: Portal vein
Nerve Plexus: Coeliac plexus @ T12
Lymphatics: Pre-aortic nodes @ T12 (coeliac nodes)

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Where is pain referred to in foregut?

Epigastric region

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Location of Stomach

Epigastric region (to left of midline)
Fundus: ~ ribs 5-6
Pylorus: L1 vertebral level at the ‘transpyloric plane’
Oesophagus meets stomach @ ~ costal cartilage 7-8

the stomach shape changes as it fills!

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Layers of stomach and what lines its inner wall?

Outer longitudinal
middle circular
inner oblique
‘Rugae’ lines the inner wall to increase SA & expandability

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Arterial Supply of lesser curvature?

Left gastric (direct from coeliac trunk) > LC and distal oesophagus
Right Gastric (from common hepatic

These anastamose

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Arterial supply of Greater curvature?

Left Gastro-omental (splenic)

- Right Gastro-omental (gastroduodenal (from CH))

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Arterial supply to Fundus

Short Gastric (splenic)
"it sits up by the spleen"

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Condition where people eat there own hair?

Trichophagia

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Structure of the foregut/midgut transition of the duodenum

Are these intra or retro peritoneal?

1st) Trans-pyloric plane is superior
2nd) Descends, wraps around head of pancreas (RHS of midline)
3rd) Inferior, crosses back over IVC & aorta (under SM vessels)
4th) Ascends to duodenojejunal flexure (LHS of midline)

1st = INTRA peritoneal
2nd, 3rd, 4th) RETROperitoneal

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Neurovascular and lymphatics to Superior half of duodenum

Arterial: Superior pancreatoduodenal branches (gastroduodenal (coeliac))
ANS: Coeliac Plexus @ T12
Venous: direct to portal vein
Lymphatic: pre-aortic coealiac nodes @ T12

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Neurovascular and lymphatics to inferior half of duodenum

Arterial: inferior pancreatoduodenal branches (SMA)
ANS: Superior Mesenteric Plexus @ L1
Venous: SMV to then form portal vei
Lymphatic: Pre-aortic SM nodes @ L1

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Difference between an ampulla and a papilla

Ampulla = swelling in a tube
Papilla = nipple like proccess (not to be confused with the sphincter that is a muscle)

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Ampulla of Vater

Union of common bile duct(liver) & main pancreatic duct

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Major duodenal papilla

Enters through descending duodenum (2nd part) and controls flow of bile (liver) and pancreatic juice (pancreas) into the duodenum vis the ‘sphincter of Oddi’

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When is the minor duodenal papilla present

When the accessory duct is present (9%)

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Component viscera of midgut

distal half of duodenum
jejunum
ileum
caecum&amp;appendix
ascending colon
2/3 transverse colon

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Neurovascular and lymphatics

Arterial: Branches of SMA (abd. aorta @L1)
Venous: SMV
Nervous: SM plexus @ L1

Lymphatics: pre-aortic nodes @ L1 (SM nodes)

Describe the Small intestine

long thin muscular tube
6m long
2/5 jejunum
3/5 ileum
suspended via body wall by mesentery

Mesentery

fan-shaped folds of peritoneum enclosing the gut tube

- allows ingress-egress of vessels, nerves and lymphatics

Whats the main identifying difference between jejunum and ileum?

arterial arcade patterning
Jejunum = 1-2 arcades with long branches (vasa recta)
Ileum = more arcades with very short branches

Arterial supply specifically to the small intestine?

branches of SMA (abd. aorta @L1) jejunal arteries ilieal arteries

The junction between SI and Colon is called?

Ileocaecal Junction

The flexures of the colon are? Which is higher?

``` Hepatic flexure (by liver) Splenic Flexure (by spleen) ``` Splenic flexure is higher as there is no liver pressing down on it

Function of the large intestine

Absorbtion of water & electrolytes | Stores undigestable materials until expelled

Haustra

Sacculations of the wall for storage

Tenae Coli

Longitudinal muscles collected into 3 bands (continuous with smooth muscle of small intestine)

Appendices Epiploicae and its clinical relevance

Fatty tags (none on Small intestine) These can become inflammed and infected and mimic appendicitis

The LI is found in all regions except

umbilical

Midgut arterial supply

Midgut = from SMA @L1 caecum/appendix: caecal & appendicular arteries (ileocoelic art.) Ascending colon: Right coelic art Proximal 2/3 Trans colon: middle coelic & marginal art.

Hindgut arterial supply

Hindgut = from IMA @L3 Distal 1/3 trans colon: marginal & left coelic art Descending colon: left colic sigmoid colon: sigmoid art

Marginal artery

anastamotic point between SMA and IMA

Weird thing ileocolic does?

Loops back on itself and anastamoses

What part of the large intestine becomes muscularised and resembles SI

descending/sigmoid colon

Midgut NV and lymphatic supply?

Art: branches of SMA @ L1 Veins: SMV ANS: Superior mesenteric plexus @ L1 Lymphatics: Pre-aortic superior mesenteric nodes @ L1

Hindgut NV and lymphatics supply?

Art: branches of IMA @ L3 Veins: IMV ANS: Inferior mesenteric plexus @ L3 Lymphatics: Pre-aortic inferior mesenteric nodes @ L3

What is the Rectum, where is it formed

The final storage deposit, SC becomes rectum @ S3 vertebral level. Pierces pelvic diaphragm at tip of coccyx to become anal canal Is retroperitoneal Sup 1/3= covered in peritoneum middle 1/3 = ant peirtoneum inf 1/3= infraperitoneal

Nervous supply and lymphatics of rectum

ANS: prximal 1/3 = IM plexus @ L3 Distal 2/3 = inferior hypogastric plexus Lymphatics: Proximal 1/3: To preaortic nodes @ L3 Distal 2/3: To internal iliac nodes

Portal vein =

Splenic(IMV) + SMV

Parasympathetic Supply from

``` Vagus nerve (CN 10) also pelvic splanchnic nerves S2-4 ```

Sympathetic Supply from

thoracic, lumbar and sacral splanchnic nerve | - from T5-L2 sympathetic ganglia (the full amount is T1-L2)

What do the PS and sympathetic control?

- viscera, glands, BVs - smooth muscle - non-concious control - motor and sensory

Splanchnic Nerves

specifically visceral nerves, go direct to organs. | Form plexus on aorta eg) coeliac, SMA plexus

Foregut ANS > where is pain refered to

S: Greater splanchnic T5-9 PS: Vagus [X] Epigastric region

Midgut ANS > where is pain refered to

S: Lesser splanchnic T10-11 PS: Vagus [X] Umbilical Region

Hindgut ANS > where is pain refered to

S: lumbar (L1-2)/sacralsplanchnic(S2-4) PS: Pelvic Splanchnic (S2-4) *no pain referral to S2-4, only to T1-2 Suprapubic region

Steps of Appendicitis?

1) appendix becomes inflamed (stretch recep.) 2) afferent sympathetic fibres refer back to T10-11 dermatomes 3) There's a broad diffuse pain around umbilical region 4) Appendix grows until it starts pressing on body way = somatic sensory pain 5) Now pain is acute, localised to LRQ