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Anatomy Gi > L3 > Flashcards

L3 Flashcards

1
Q

Boundaries of the pharynx: Posterior

A

Vertebral column and prevertebral muscles

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2
Q

What separates the pharynx from the cervical vertebra?

A

the prevertebral layer of deep cervical fascia

✨ the prevertebral fascia covers the prevertebral muscle,so from outside to inside you have:
Vertebral column>prevertebral muscle>prevertebral layer of fascia>buccopharyngeal fascia,which is fascia of the pharynx.

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3
Q

Boundaries of pharynx - superior?

A

Base of the skull which is formed by the sphenoid + occipital bones

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4
Q

Boundaries of pharynx - anterior

A

Continuous with nasal, oral, and larynx cavities

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5
Q

Boundaries of pharynx - inferior

A

esophagus (C6) + cricoidcartilage

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6
Q

Mention the attachments of the pharynx? 3p t m 3oid

A
  • Medial pterygoid plate
  • Pterygoid hamulus
  • Pterygomandibular raphe
  • Mandible
  • Tongue
  • Hyoid bone
  • Thyroid cartilage
  • Cricoid cartilage
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7
Q

Nasopharynx borders?

A

1-Roof/superior= pharyngeal tonsil (adenoid)
2-Lateral walls= tubal elevation (which has tubal tonsil) + tubal opening (opening of auditory tube) + pharyngeal recess (common site for carcinomas)

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8
Q

What makes the tubal opening in the lateral wall of pharynx?

A

produced by a muscle(salpingopharyngeus) and the medial end of auditory tube.

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9
Q

Common site for carcinomas in the nasopharynx?

A

Pharyngeal recess

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10
Q

Innervation of nasopharynx and types of epithelium?

A

Pharyngeal branch of pteryopalatine ganglion

Ciliated columnar to pseudo-stratified (cc ps)

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11
Q

Ooropharynx borders?

A 
Anterior = oral cavity & palatoglossal arch
Posterior = c2 c3 vertebra 
Laterally= tonsillar fossa occupied by palatine tonsil
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12
Q

What makes the tonsillar fossa?

A

Palatoglossal arch and palatopharyngeal arch ( between them palatine tonsil) mood

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13
Q

Innervation of ooropharynx?

A

Innervated by IX and X CN

9 10

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14
Q

Epithelium of ooropharynx

A

Lined by stratified squamous non- keratinized epithelium (ss)

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15
Q

Ooropharynx is from soft palate to epiglottis

A

Hehe

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16
Q

Laryngopharynx borders

A 
Anterior = i c aryt ( inlet of larynx - cricoid cartilage - arytnoid cartilage)  
Posterior = c4 - c6 
Lateral = piriform fossa
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17
Q

Epithelium and innervayof layrngopharynx

A

Ss nk

Innervation 9+10

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18
Q

What can happen in piriform fossa?

A

Food and bones can get stuck there

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19
Q

What can be injured during the removal of bone pieces from piriform fossa?

A

Internal Laryngeal n.

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20
Q

Structures of pharynx From inside to outside:

A
  1. Mucosa (The inner most layer)
  2. Submucosa
  3. Pharyngobasilar fascia (pharyngeal aponeurosis)
  4. Muscular layers (inner longitudinal and outer circular)
  5. Buccopharyngeal fascia
    (The outer most layer)
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21
Q

Constrictor (circular) muscles of pharynx?

A

superior, middle and inferior constrictor (the cone )

Inferior constrictor has two parts- thyropharyngeus and cricopharyngeus

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22
Q

Origin and insertion of the circular constrictor muscles in the pharynx?

A

All of them take origin anteriorly and their fibers course laterally and posteriorly to the midline where they meet each other at the PHARYNGEAL RAPHE

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23
Q

There are two layers of muscles in GI

A

✨ in the pharynx:inner longitudinal ,outer circular

✨ in the rest of GI tract:outer longitudinal, inner circular

24
Q

Where is the pharyngeal plexus

A

it lies in the posterior aspect of the middle constrictor muscle(not only the middle constrictor also the other constrictors but mainly the middle constrictor).

25
Q

what are the nerves that contributes to pharyngeal plexus?

A

1-vagus 2- glossopharyngeal 3- sympathetic

the middle constrictor and the superior constrictor muscles are supplied directly by the vagus nerve through pharyngeal plexus.

26
Q

A weak point in the posterior aspect of inferior constrictor muscle (thyropharyngeus) what’s this called?

A

killian’s dehiscence; weakness in the posterior lower aspect of the thyropharyngeus muscle

27
Q

In the inferior circular constrictor muscle of the pharynx, aka he thyropharngeus, the posterior lower aspect is weak cuz its not covered by muscles = killians weak point

28
Q

normallly when you eat food, the thyropharyngeus will contract and the cricopharyngeus relax so that the food will move down.
✨ what will happen if the cricopharyngeus didn’t relax?

A

If the cricopharyngeus didn’t relax ,the food can form a diverticulum in the weak point(killian’s dehiscence) which will project posteriorly in the midline and this diverticulum is called zenker’s diverticulum which contains food material,and this diverticulum can be seen in barium X-ray.

29
Q

Why does pharyngeal/zenker diverticulum happen?

A

1-Because of the neuronal incoordination between thyropharyngeus and cricopharyngeus.
2-the thyropharyngeus is supplied directly by vagus nerve through the pharyngeal plexus, whereas, the cricopharyngeus is supplied by recurrent laryngeal nerve, and although that the recurrent nerve is a branch of vagus but they have neuronal incoordination

30
Q

Laimer’s traingle:

A

this is also a week point and you can see some time diverticulum that is produced by food.
Location:below the cricopharyngeus where the esophagus begins
Characteristics:there is only circular muscles and there is no longitudinal muscles.
Note:the esophagus has outer longitudinal and inner circular muscles)

31
Q

Longitudinal muscle layer of pharynx

A

Salpingopharyngeus
Origin- cartilage of auditory tube Insertion-blends with palatopharyngeus

Palatopharyngeus
Origin-Hard palate and palatine aponeurosis
Insertion- thyroid cartilage and wall of pharynx

Stylopharyngeus
Origin- styloid process
Insertion- thyroid cartilage

32
Q

Motor Innervation of pharynx?

A

All by vagus except stylopharyngeus by 9; glossopharyngeal

33
Q

Parasympathetic Innervation of pharynx?

A

Facial = lesser petrosal

34
Q

Esophagus extends from?

A

C6 + cricoid cartilage

35
Q

In the neck- esophagus is related to?

A

Anterior: trachea, thyroid, recurrent laryngeal nerves

Posterior:prevertebral muscles and vertebral column

On each side: thyroid lobes and carotid sheath (which consist of common carotid,internal carotid,vagus,IJV)

36
Q

Esophagus shows two curvatures,where?

A

the upper thorax(between T1 and T2)
lower thorax at T7

Both curvatures deviated to left

37
Q

The esophagus pierces the diaphragm at the level?

A

at level T10 and becomes the abdominal part of the esophagus

38
Q

Where are the esophagus constrictions located?

A

Cricopharynx - C6 - 15cm
Aortic arch - T4 - 25 cm
Lt bronchus - T5 - 28 cm
Esophageal hiatus (pierce diaphragm)- T10 - 40 cm

39
Q

What is Barium swallowing(radiocontrast) used for?

A

Is used for taking X-ray for the esophagus

40
Q

when the left atrium enlarges because of mitral stenosis it will compress the esophagus,so it is a pathological constriction.

41
Q

Relationships of esophagus in the thorax

A

Anterior :
Trachea, left bronchus, right pulmonary artery, pericardium, left atrium

Posterior:
Vertebral column, thoracic duct, azygos vein, thoracic aorta

42
Q

Abdominal esophagus is 1.25 cm long and enters stomach at

A

Level t11 (left 7th costal cartilage)

43
Q

✨ the esophagus in the abdominal region (after esophageal hiatus) is covered by peritonium.
✨ the thoracic and cervical parts are covered by adventitia (not covered by peritoneum)
So?

A

because they are not covered by peritoneum, the metastasis of esophageal cancer is very common in these sites.

44
Q

In the lower end of esophagus there is a Z-line,where the esophagus is continues with the stomach. What happens in the Z line?

A

in this line,the stratified squamous epithelium of esophagus immediately becomes simple columnar epithelium of the stomach.

✨ Z-line is common site for esophageal adenocarcinoma.

45
Q

the epithelium lining the esophagus is?

A

stratified squamous non ketatinized epithelium .

46
Q

there are two types of glands in the esophagus,and both of them have ducts and secrete mucin(mucous glands):

A

1-submucousal gland in the submucousa
»found every where
&raquo_space;secrete acidic mucous
2-mucosal gland in the mucousa
»found in the lamina propria,and in the beginning and at the end of esophagus.
»they secrete neutral mucousa.

47
Q

Note :the skeletal muscles (non voluntary)in the upper part of muscularis externa are supplied by recurrent laryngeal branch of vagus.

48
Q

Blood supply of esophagus?

A

Cervical esophagus = inf thyroid artery

Thoracic esophagus = bronchial artery + thoracic aorta

Abdominal esophagus = left gastric artery

49
Q

Esophagus is attached to the margins of the esophageal hiatus by ?

A

phrenico-esophageal ligament

The ligament permits independent movement of the diaphragm and esophagus during respiration and swallowing

50
Q

Venous drainage of esophagus?

A

Cervical esophagus = inf thyroid veins then to jugular system

Thoracic esophagus = azygos veins + hemi-azygos veins

Abdominal esophagus = left gastric vein (portal system)

51
Q

esophageal varices

A

Anastomosis between the left gastric vein (portal system) and azygos vein

✨ in liver cirrhosis ,when portal hypertension occur, the blood flows in opposite direction and forms some accumulation in the lower part of esophagus .

52
Q

Lymphatic drainage of esophagus?

A

Cervical esophagus = Inferior deep cervical lymph nodes

Thoracic esophagus = posterior mediastinal lymph nodes

Abdominal esophagus = Left gastric lymph nodes

53
Q

Check the innervation of esophagus in the note

54
Q

Sinus of Morgagni

A

Space between the superior constrictor, base of the skull and pharyngeal aponeurosis.

Nasopharyngeal carcinoma may invade laterally to this sinus resulting three symptoms (Trotter’s triad)-conductive deafness, ipsilateral paralysis of soft palate, and trigeminal neuralgia

55
Q

Superior middle and thyropharyngeus are innervated by

A

Pharyngeal plexus thro vagus

Anatomy Gi (2 decks)

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