Hulka Anatomy Small and Large Intestine Flashcards by Danielle Hayes

What is the first portion of small intestine and where does it end?

duodenum

ends at ligament of trietz

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What is the shortest portion of the small bowel?

duodenum

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The duodenum except for the first 2-3 cm, is a completely (blank) structure

retroperitoneal

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What is this:
In continuity with the pylorus
Is the intraperitoneal portion
Approximately 2-3 cm in length
Also referred to as the duodenal bulb
The common bile duct, gastroduodenal artery and inferior vena cava run posterior to this portion of the duodenum

First portion of duodenal

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(blank) can develop in the duodenal bulb due to increased acidity entering the bulb from the stomach

ulcers

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If ulcers are on anterior wall of duodenum it will perforate (blank) and result in acute abdominal pain.

intraperitoneal

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If ulcers are on posterior wall of duodenum it will perforate into the (blank) and have it bleed extensivly.

gastroduodenal artery

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What is this:
Where the duodenum becomes retroperitoneal
Approximately 8-10 cm in length
Also referred to as the “C loop”
Where the pancreatic and common bile duct drain into the duodenum through the ampulla of Vater (hepatopancreatic ampulla)

second portion of duodenal

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What portion of the duodenum is the C loop?

2nd portion

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What is this:
ends where the superior mesenteric vessels cross
Approximately 5-8 cm in length
Also referred to as the horizontal portion
Where the duodenum proceeds horizontally over the spine from right to left

3rd portion of duodenum

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What is this:
Begins to left of superior mesenteric vessels
Ends at the ligament of Trietz
Approximately 2-3 cm in length
Also referred to as the ascending portion
Duodenum proceeds superiorly to the left side of abdomen and acute turn where it becomes the jejunum

fourth portion of duodenum

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What is the blood supply to the pancreas?

Superior pancreaticoduodenal artery from the gastroduodenal artery
Inferior pancreaticoduodenal artery from the superior mesenteric artery

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What is the venous drainage of the duodenum?

Into superior mesentaric vein (entering portal system)

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What is the lymphatic drainage of duodenum?

Drain primarily into pancreaticoduodenal lymph nodes

These ultimately drain into the celiac lymph nodes

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What is this:
The intestine exits the fetus at 7-8 weeks development and then returns in a rotated position…or sometimes not.
Present with bilious vomiting to septic secondary to mid gut volvulus

malrotation

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What is this
Second and third portions of the small intestine
Begins at the ligament of Trietz
Ends at the ileocecal valve
No obvious demarcation between these 2 things.
Both total approximately 6-7 meters
First 2/5ths thought to be (blank)

jejunum and ileum

jejunum

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(blank) is usually thicker and more muscular than ileum

Jejunum

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(blank) is the more proximal portion so resides in the upper abdomen

Jejunum

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(blank) is more distal so resides in the pelvis and lower abdomen

Ileum

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(blank) in the mucous membrane are large and well developed in the jejunum and Provides a more absorptive surface

Circular folds (plicae circulares)

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Jejunum and ileum are suspended by a (blank)

mesentery

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(blank) carries blood vessels and lymphatics.

mesentary

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(blank) Emanates from superior mesenteric vessels and fans out with the bowel along the edge of the mesentery

root of the mesentary

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Entire blood supply to jejunum and ileum comes from the (blank)

superior mesenteric artery

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SMA provides (blank) branches to jejunum and ileum

15-18

Arteries unite to form (blank)

arterial arcades

From arterial arcades,what arise?

vasa recta or “straight vessels” arise

(blank) enter bowel on the mesenteric border

Vasa recta

Does the SI have collateral circulation?

yes via the vasa recta, arterial arcades

Entire blood supply to jejunum and ileum drains into the (blan) vein. Veins and venules follow arterial supply

superior mesenteric vein

(blank) are lymphatics in the intestinal villi

Lacteals

Lacteals drain into a lymph vessel plexus in the (blank).

mesentery

Lacteals drain into a lymph vessel plexus in the mesentery | Plexus drains into (blank)

mesenteric lymph nodes

What are the three levels of mesenteric lymph nodes? | The lymphatics will ultimately drain into the (blank)

Next to intestine Along arterial arcades Along SMA cisterna chyli and into the thoracic duct

What are the nerves of the small intestine?

Vagus and splachnic nerves

(blank) is a 3-6 cm long pouch found in the ileum within 50 cm of the ileocecal valve - persistent base of duct May have fibrous cord connecting to umbilicus

Meckel's diverticulum

Embryologically, (blank) drains intestinal contents from distal small bowel through umbilicus in the womb

omphalomesenteric duct

In the small intestine, parasympathetics arising from (blank) stimulates (blank)

vagus nerve | motility

In the small intestine, sympathetics from superior mesenteric ganglion mediate pain from T(blank)

T9-T10

Does the vagus sense pain?

Where is meckels diverticulum?

in the ileum

What can present with bleeding or obstruction in the ileum?

meckels diverticulum

What is this: Begins at the ileocecal valve, at the cecum Ends at the anus Approximately 1.5 meters long

Large intestine

What Absorb water from feces and | Stores feces?

large intestine

What is this: | Three longitudinal muscle bands that run along the entire colon

teniae coli

What is this: | Permanent sacculations between teniae involving the circular muscle

Haustra Coli

What are the distinguishing features of Large intestine?

Teniae coli haustra coli Appendices epiploicae

(blank) are fatty appendages that are attached to the teniae

appendices epiploicae

What is this: Begins at ileocecal valve Is first portion of ascending or right colon Sac like structure

cecum

What is the blood supply to the cecum?

ileocolic artery (branch of SMA)

What is this: Vestigial portion of GI tract Function unknown - has lymphoid tissue Begins at confluence of teniae coli, at base of cecum

vermiform appendix

What is the blood supply to the appendix?

ileocolic artery-branch of SMA

What is the most important question to ask patients?

how did things change

What is this: Approximately 250,000 cases annually in US Highest incidence in age group 10-19 Classic presentation: Periumbilical pain moving to right lower quadrant Nausea +/- vomiting Fever is later finding

appendicitis

``` What is this: Begins at cecum Ends at the hepatic or right flexure Approximately 12-20 cm long Lies retroperitoneally, along right side of abdomen ```

ascending or right colon

Where is the appendix in relation to peritoneum?

it can be intraperiotoneal or retroperitoneal

What is the blood supply to the AC of the large intestine?

Right colic artery-branch of SMA

``` What is this: Begins at hepatic or right flexure Ends at the splenic or left flexure Approximately 30-50 cm long Lies intraperitoneally, draped across abdomen from right to left side of abdomen ```

transverse colon

What is the blood supply to the transverse colon?

middle colic artery-branch of SMA

What is this: Begins splenic or left flexure Ends at the brim of pelvis - becomes sigmoid colon Approximately 15-20 cm long Lies retroperitoneally, along left side of abdomen

descending or left colon

What is the blood supply to the left colon?

Left colic artery - branch of IMA

``` What is this Begins pelvic brim - “S” shaped loop Ends at S3- becomes rectum Approximately 15-80 cm long Lies intraperitoneally, in the left lower quadrant ```

sigmoid colon

WHat is the blood supply to the sigmoid colon?

sigmoid arteries (2 or 3)-branches of IMA

(blank) are Outpouchings of mucosa between teniae coli in colon

diverticuli

diverticuli can occur anywhere in the colon, most commonly in the (blank)

sigmoid colon

What are these complications of: | Complications include infection (diverticulitis) or bleeding (diverticular hemorrhage)

diverticuli

``` What is this: Begins at S3 Ends at the anus Approximately 12-15 cm long Lies retroperitoneally, in the pelvis ```

Rectum

What is the blood supply to the rectum?

Superior rectal artery-branch of IMA | Middle and inferior rectal arteries-branches of internal iliacs

Are there haustra or diverticuli or tinea coli in the rectum?

What are the internal folds of the rectum? | What do they do?

transverse rectal folds | aids in supporting feces

(blank) functions to store feces before defecating

Rectum

Since the rectum goes through the pelvic floor, there are no (blank)

diverticuli

``` What is thsi: Terminal portion of GI tract Approximately 2.5-5 cm in length Begins at the puborectalis muscle Surrounded by internal and external sphincters Internal anal sphincter - involuntary External anal sphincter - voluntary ```

anus

What is the innervation to the anus?

External anal sphincter - inferior rectal nerve

What is the blood supply to the anus?

Superior rectal artery supplies the superior part of canal | Inferior rectal arteries supply inferior part of canal

What are some anal pathologies?

perirectal/perianal abscesses | Hemorrhoids (internal from superior rectal vein and external from inferior rectal vein)

What is the lymphatic drainage of the cecum/appendix?

Periappendiceal LN -->superior mesenteric LN

What is the lymphatic drainage of the ascending colon?

Paracolic LN -->superior mesenteric LN

What is the lymphatic drainage of the transverse colon?

Superior mesenteric LN

What is the lymphatic drainage of the descending colon?

inferior mesenteric LN

What is the lymphatic drainage of the sigmoid colon?

inferior mesenteric LN

What is the lymphatic drainage of the rectum?

-Superior portion Pararectal LN -->Inferior mesenteric LN -Inferior portion Internal iliac LN

What is the innervation of the colon?

Colon: superior and inferior mesenteric plexus

What is the innervation of the rectum?

Middle rectal plexus -->from inferior hypogastric plexus

What is this: Mucosa similar to rectum Has folds called anal columns

Superior portion of anus

What is this: | Anal columns end in anal valves

inferior portion of anus

Superior and inferior portions of anus is separated by (blank)

pectinate line

What portions of the small and large intestine are retroperitoneal?

duodenum ascending/right colon descending/left colon rectum