HARC - Gastrointestinal Flashcards
1
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Anatomy of GI system
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3
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Phases of digestion
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4
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Phases of digestion
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5
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Phases of Digetsion
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6
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Mouth
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7
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Tongue
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Stomach
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Liver
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Pancreas & Biliary Tree
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11
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Large intestine
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12
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The layers - Generalised
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13
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Innervation of the GI tract
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Innervation of the GI tract
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15
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Where do theses branch from? and at what level (for each)?
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Abdominal Aorta
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What branches after the splenic artery?
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17
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What branches after the left gastric artery?
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18
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What branches after the common hepatic artery?
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Large intestine
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Veins of the GI system
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Veins of the GI system
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Outline the GI pathway
Ingestion of food
Secretion of fluids and enzyme
Mixing and movement through the body
Digestion of food into smaller pieces
Absorption of nutrients
Excretion of wastes
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GI pathway - Stomach
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GI Hormones summary:
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What is the abdominal cavity lined by?
Peritoneum
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What does the peritoneum consists of?
an epithelial-like single layer of cells (the mesothelium) together with a supportive layer of connective tissue
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Parietal peritoneum lines the _______ \_\_\_\_
Visceral peritoneum covers _________ \_\_\_\_\_\_
Abdominal wall
Suspended organs
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Sagittal section of the abdomen
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Sagittal section of the abdomen
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The liver has both a \_\_\_\_\_\_\_\_\_\_(lies in relation to the diaphragm) and a \_\_\_\_\_\_\_\_\_(lies in relation to other organs) surface.
diaphragmatic
visceral
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What is the hilum of the liver (the area where vessels enter and exit the organ) is known as?
and where does it lie?
porta hepatis
posteroinferior surface of the liver.
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What are the names given to the structures that make up the porta hepatis and what is their position in the porta hepatis?
There are three structures in total.
From anterior to posterior: common hepatic duct, hepatic artery proper and hepatic portal vein
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Common hepatic duct
Hepatic artery proper
Hepatic portal vein
: How does each of the structures mentioned above, reach the porta hepatis?
Common hepatic duct – Left right hepatic ducts
Hepatic artery proper – Celiac trunk
Hepatic portal vein – Portal venous system
41
Name the abbreviations
Right lobe
Left lobe
Anterior coronary ligaments
Falciform ligament
Ligamentum teres
Gall bladder
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Name the abbreviations
quadrate lobe
caudate lobe
Bare area
Right and left triangular ligaments
Ligamentum venosum
Ligamentum teres
Gall bladder
Anterior and posterior coronary ligaments
43
Why is gall bladder on a cadver green?
due to the breakdown of bile releasing bile pigments such as bilirubin.
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What does gall bladder store?
bile that is produced in the liver
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When a fatty meal is consumed, ____________ levels are increased and induce the release of bile.
When a fatty meal is consumed, **cholecystokinin (CCK)** levels are increased and induce the release of bile.
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What is A-E
A = Right hepatic duct
B = Left hepatic duct
C = Common hepatic duct
D = Cystic duct
E = Bile duct
47
What route does bile take from the gallbladder to the duodenum?
Gall bladder → Cystic duct → joins common hepatic duct to become bile duct →hepatopancreatic ampulla
48
Name the different parts of the gallbladder (indicated by “?” on the diagram)
From superior to inferior on the diagram –
Fundus, body and neck
49
The bile duct is joined by the pancreatic duct forming the _____________________ and enters the second part of the duodenum at the major duodenal papilla.
**hepatopancreatic ampulla of Vater**
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What is the name of the sphincter that controls secretion at the major duodenal papilla?
Sphincter of Oddi (hepatopancreatic sphincter)
51
The mouth, or oral cavity, is lined by\_\_\_\_\_\_\_\_
mucous membrane
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The point at which the oral cavity and the pharynx are continuous is called\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_
oropharyngeal isthmus
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The opening of the mouth which opens onto the face is called ___ \_\_\_\_\_\_ \_\_\_\_\_
the oral fissure
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**Palatoglossal arches** mark the boundary between the ____ \_\_\_\_\_ and the \_\_\_\_\_\_\_\_\_\_
oral cavity
oropharynx
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Where are Palatoglossal arches located?
anteriorly to the palatopharyngeal arches
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Name A-F
A = oral part of tongue
B = Terminal sulcus
C = Lingual tonsil/pharyngeal part of tongue
D = Foramen caecum
E = oropharynx
F = lingual tonsil/pharyngeal part of the tongue
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Name the missing labels
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What endocrine gland originates at Foramen caecum?
Thyroid gland
60
Identify A-E
A = lateral arcuate ligament
B = medial arcuate ligament
C = median arcuate ligament
D = Right crus of the diaphragm
E = Left crus of the diaphragm
61
What vertebral levels are represented at each (yellow star) ?
T8 T10 T12 L2 L3
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Describe what passes through the diaphragm at T8, T10 and T12
T8 – IVC
T10 – Oesophagus and vagus
T12 – Aorta and cysterna chyli
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What differences do you notice between the beginning and end of the small intestine?
Longer and straighter like ‘church windows’ in the jejunum. Has a more honeycomb appearance in the ileum.
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A = Coeliac Trunk
B = Superior mesenteric artery
C = Inferior mesenteric artery
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Coeliac Trunk
Superior mesenteric artery
Inferior mesenteric artery
Which organs are supplied by each artery?
**Coeliac Trunk** – Supplies the liver, stomach, abdominal oesophagus, spleen and superior half of the duodenum and pancreas. It represents the embryonic foregut.
**Superior mesenteric artery** – Supplies the head of the pancreas, ascending and inferior parts of the duodenum, ileum and jejunum, caecum, appendix, ascending colon and 2/3 of the transverse colon.
**Inferior mesenteric artery** – Supplies 1/3 transverse colon, descending colon, sigmoid colon, rectum
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Normally, all of the hepatic portal system drains into the systemic circulation via the \_\_\_\_\_\_\_
Normally, all of the hepatic portal system drains into the systemic circulation via the **hepatic veins**
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If hypertension (elevated pressure) occurs in the portal vein such as in a scarred liver which is blocking blood flow, blood will instead drain through areas known as \_\_\_\_\_\_\_\_\_\_\_\_
If hypertension (elevated pressure) occurs in the portal vein such as in a scarred liver which is blocking blood flow, blood will instead drain through areas known as **portosystemic anastomoses**
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Gastroesophageal junction
Anterior abdominal wall around the umbilicus
Anal canal/Rectum
What is the result of increased pressure at these three areas?
Oesophageal varices
Caput Medusae
Rectal varices
74
Name the two plexuses involved in the enteric nervous system
A= Submucosal plexus /Meissner’s plexus
B = Myenteric plexus/Auerbach’s plexus
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What is the enteric nervous system?
The enteric nervous system is part of the autonomic nervous system that controls gastrointestinal motility and secretions; furthermore it acts to function independently of the brain and spinal cord.
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Between which layers in the wall of the GI tract can they be found (C, D & E)? Look at the image below to help.
C = Submucosa
D = Circular muscle layer
E = Longitudinal muscle layer
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Where does the vagus (parasympathetic) innervation end in the gut?
What takes over to supply parasympathetic innervation of the hindgut?
2/3 along transverse colon
pelvic splanchnic nerves take over S2-S4
78
Describe the pain felt from visceral afferent fibres compared to somatic afferent fibres.
Visceral afferent has no pain fibres but sometimes is referred and is not localised. Somatic afferent fibres carry pain fibres and is localised.
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What is occurring when pain is referred?
For example in the early stages, when the appendix becomes inflamed, visceral sensory fibres are stimulated.
Where will the pain be felt?
Visceral afferent pain is referred to the dermatome of that spinal level - appendicitis irritates the visceral peritoneum first so in early appendicitis pain is referred to T10. It later affects the parietal peritoneum and becomes localised in the right iliac region as parietal peritoneum is supplied by somatic afferent fibres.
80
What are these triangles called in the pelvic floor?
What central structure in the middle of the “diamond shape” separates the 2 triangles?
Urogenital triangle (anterior)
anal triangle (posterior)
81
Explain in terms of innervation, why one anal sphincter is voluntary and why one is involuntary.
Which one is which?
The sympathetic and parasympathetic nervous system controls and regulates the internal anal sphincter – it is involuntary. The sympathetic component causes contraction of the sphincter and the parasympathetic component is inhibitory to the sphincter causing relaxation.
The external anal sphincter is voluntary, and is supplied by the inferior rectal nerve (S2 and S3) and the perineal branch of S4. These are somatic nerves.
82
The puborectalis, iliococcygeus and pubococcygeus together form what muscle?
83
What important function does the puborectalis do?
Forms a muscular sling and creates and angle, convex forwards, at the anorectal junction = perineal flexure. Therefore the pelvic floor needs to relax when defecating in order to allow ‘straightening’ of this perineal flexure.
84
Identify the structures on the diagram of the external anal sphincter below:
A = Levator ani
B = Internal anal sphincter
C = Deep part of external anal sphincter
D = Superficial part of external anal sphincter
E = Subcutaneous part of external anal sphincter
85
Identify the labels on the diagram
A = Anal sinus
B = Anal column
C = White line of Hilton
D = Anal pecten
E = Pectinate line
F = Anal valve
