Jan31 M3-Anatomy Lecture 3 Flashcards
4 parts of stomach
cardia, fundus (bulging), body, pylorus
2 sphincters in stomach
LES in beginning
pyloric sphincter
two parts of LES and real functional part and why
external and internal sphincter. internal sphincter is real. (in wall of tube itself), constant tone
external sphincter of LES composition and function
diaphragm forms right crus and left crus but right crus surrounds whole LES. when breathe in, it tightens.
LES innvervation
autonomic (not voluntary)
hiatus hernia def
protrusion of upper part of stomach in thorax through tear or weakness in diaphragm
what might be weak in the diaphragm, causing a hiatus hernia
external sphincter of LES
2 types of hiatal hernias and %
sliding (95%) and paraesophageal (5%)
sliding hiatal hernia def
stomach + esophagus move up and down together. stomach starts above diaphragm (gastroesophageal junction above it)
paraesophageal hiatal hernia def
part of stomach is squeezed up above the diaphragm (but junction didn’t move)
pyloric spasm or stenosis cause and consequence
congenital hypertrophy of pyrolic sphincter.
bloated stomach in baby and vomits
vomit of pyrolic spasm or stenosis vs other disease
doesn’t have bile bc bolus doesn’t get beyond pylorus
4 parts of duodenum and intra or retroperitoneal
D1 exits stomach (intra then retro)
D2 vertical retro
D3 horizontal to the left (retro)
D4 vertical loop up and jejunum when down (retro then intra)
what’s on top of DI
gastroduodenal (or hepatoduodenal) ligament (contains bile duct, veins, etc.)
3 flexures in duodenum + location
superior duodenal flexure (D1 to D2)
inferior duodenal flexure (D2 to D3)
duodenojejunal flexure (between D4, vertical going up, and jejunum)
what happens in D2
bile duct and pancreatic duct open (there’s an ampula)
how right crus of diaphragm surrounds esophagus (and LES)
starts on right, goes up top on right, surrounds it to the left and back down from the left to the right
special landmark at D4
duodenojunal ligament or ligament of Treitz or suspensory muscle of the duodenum
ligament of Treitz function and composition
band of CT and muscle joining right crus of diaphragm
what’s between ileum and cecum and function
ileocecal valve. prevents reflux from cecum to ileum
how to differentiate jejunum and ileum from outside
ileum: more fat in mesentery, Peyer’s patches (aggregations of lymphoid tissue) more arterial arcades, shorter straight arteries (vasa recta). ileum has more levels of arcades
Meckel’s diverticulum % of pop and what it is
(in ileum). 2-3%. congenital prob where obliteration of vitelline duct (connecting fetus to yolk sac of umbilical cord) is incomplete (incomplete closure)
jejunum vs ileum on inside
jejunum has plicae circulares
ileum is smooth
Peyer’s patches def and where to see them
accum of unencapsulated lymphoid nodules, on inside of ileum
intussusception def
part of intestine invaginated into another section of intestine (intestine folds on the side)
ileocecal valve real composition
not a valve but rather a thickening of the ileum wall
appendix location
hangs on cecum
cecum intra or retroperit
intraperitoneal
method for identifying appendix: name + description
McBurney’s point. go from umbilicus to ASIS and then even further by 1 third of the umbilicus to ASIS distance
clinical relevance of appendix pain in McBurney’s point
inflammation no longer limited to bowel lumen (which has poor pain localization) and is irritating the lining of the peritoneum (where perit touches appendix). greater likelihood of rupture
2 reasons for variations of appendix position
can be in diff places bc of gut rotation
+ situs inversus, will be on the left
5 parts of large intestine
ascending, transverse, descending colon
sigmoid colon
rectum
flexures in large intestine
hepatic flexure (ascending to transverse) splenic flexure (transverse to descending)
why bulges in colon + name of the bulges
(called haustra). three stripes of longitudinal SM along colon called taenia coli (shorter than colon so bulge it outwards)
haustra importance in bowel fct + singular
peristaltic mvmt importance. one haustra filled then stretched and squeezes
singular is one haustrum
name of peristaltic mvmt caused by haustra + frequency
haustral contractions. once in 25 minutes
epiploic (omental) appendices def
small pouches of peritoneum filled with fat. along colon and upper rectum (mostly in transverse and sigmoid)
diverticulosis def and location
pocket of membrane sticking out bc of pressure, bulging outwards. (mucosa and submucosa outpocketing bc of weak SM)
diverticulosis causes and frequent location
weakness of wall with age, or congenital or etc.
often sigmoid colon bc place of high P
problem of diverticulosis
if ruptures, can get severe abd pain quickly, progressing, septick shock
volvulus def
loop of bowel completely twisted on itself at its mesenteric attachement. looks like kidney bean
2 reasons for symptoms in volvulus
- bowel obstruction = abd distension, vomiting, lack of defecation
- ischemia to the affected portion
3 main branches of aorta feeding intestinal system and liver + what they feed
- celiac trunk: liver + up to middle of duodenum
- sup. mesenteric a.: after middle duod until two thirds of transverse colon
- inf mesenteric a: last third of transverse colon + the rest
3 branches coming off celiac trunk and what they feed
- common hepatic a. to the right
- splenic a. to the left (to the spleen)
- left gastric a. (to lesser curvature of stomach)
lienorenal ligament location and why exists
pouch on back side of spleen bc of spleen and splenic artery connection
3 branches of splenic artery and what they feed
- short gastric arteries to fundus
- splenic arteries to the spleen
- left gastropepiploic a. to the stomach (and becomes RGE)
2 branchings of common hepatic a.
proper hepatic a. and gastroduodenal a.
proper hepatic a. branchings
- left hepatic a.
- right hepatic a.
- cystic a. (to the bile duct)
gastrooduodenal artery branchings (2) and what they feed
- RGE a. (anastomoses with LGE a.). greater curvature of stomach
- superior pancreaticoduodenal a. (feeds top of duodenum and head of pancreas)
blood supply to the rest of the pancreas (other than the head)
no specific supply. gets blood from arteries all around
superior mesenteric a. branchings on its left side
jejunal arteries and ileal arteries
superior mesenteric a. branchings on its right side and what they feed
- ileocolic artery (to terminal ileum, cecum, appendix, lower ascending)
- right and middle colic arteries (to upper ascending and transverse)
branchings of the inferior mesenteric a. and what they feed
left colic artery artery becomes sigmoid arteries on left and superior rectal artery on the right: last part of transverse, descending, sigmoid and upper rectum
marginal artery def
artery formed by anastomoses all along the margin of the colon
why inferior mesenteric a. hard to see
autonomic nerves covering aorta
what forms the portal vein
splenic vein, SMV and IMV
why everything joins in portal vein and can’t drain in IVC
need to send the nutrients to the liver for it to process them
SMV vs IMV general regions they drain from
SMV drains from second half of duodenum to first half of transverse
IMV drains from 2nd half of transverse to upper rectum
IMV joins where exactly
in splenic vein or SMV (there are variations)
