Lecture 17: GI Tract Flashcards by Elle Chapman

what is peritoneum?

-serous membrane that lines the walls of the abdominal and pelvic cavities, and covers many organs
-forms a sac that encloses the peritoneal cavity

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Mesentery

-double fold
-connects parietal and visceral peritoneum

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intraperitoneal organ

surrounded by visceral peritoneum

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2 main types of peritoneum

-Parietal
-Visceral

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Pariteal peritoneum

= of walls
-outer ring

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what does the parietal peritoneum line

-inferior surface of diaphragm
-abdominal & pelvic walls
-roof over pelvic viscera

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what does the visceral peritoneum cover

organs

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2 sacs of peritoneal cavity

greater and lesser

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greater sac

diaphragm -> pelvis

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lesser sac

-behind the stomach
-can extend:
upward -> diaphragm

downwards -> between ayers of greater omentum

Left -> spleen

right -> Epiploic foramen of winslow

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Intraperitoneal

-hanging via messentary
-completely covered by peritoneum

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intraperitoneal muscles

liver, stomach, spleen, jejunum, ileum

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Retroperitoneal

-behind parietal peritenium in posterior abdominal wall
-anterior surface covered

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Retroperitoneal muscles

SAD PUCKER
Suprarenal/adrenal glands
Abdominal Aorta and IVC
Duodenum
Pancreas
Ureters
Colon (ascending & descending)
Kidneys
Esophagus
Rectum

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double peritoneal folds

-mesentery
-lesser omentum
-greater omentum
-ligaments

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what is in the mesentery

arteries and veins of GI tract

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what does the lesser omentum sit between

between liver and lesser curvature of stomach

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what acts as an apron over the GI tract

greater omentum

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innervation of parietal peritoneum (retroperitoneal)

-segmental nerves: overlying skin & muscles (T6-L1)
-phrenic nerves
-pain is well localized

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innervation of visceral peritoneum (intraperitoneal)

-visceral afferents (secondary nerves)
-pain is poorly localized

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3 parts of the gut tube

Foregut
Midgut
Hindgut

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Foregut

abdominal esophagus to proximal 1/2 of duodenum
-esophagus
-stomach
-liver
-gallbladder
-bile ducts
-pancreas
-proximal duodenum

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foregut purpose

digestion

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Midgut

distal 1/2 of duodenum to proximal 2/3 of transverse colon
-distal duodenum
-jejunum
-ileum
-cecum
-appendix
-ascending colon
-proximal 2/3 transverse colon

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Midgut purpose

absorption (ends digestion)

Hindgut

distal 1/3 of transverse colon to proximal anal canal -distal 1/3 transverse colon -descending colon -sigmoid colon -upper anal canal

hindgut purpose

removal of waste

blood supply to the foregut

celiac trunk

blood supply to the midgut

superior mesenteric artery

blood supply to the hindgut

inferior mesenteric artery

Branches off the celiac trunk that supply the foregut

-common hepatic artery -left gastric artery -splenic artery

branches off the SMA that supply the midgut

-inferior pancreaticoduodenal artery -jejunal arteries -Ileal arteries -middle colic artery -right colic artery -Ileocolic artery

no hindgut blood supply to

small intestine

midgut SMA branching

-middle colic artery -right colic artery -Ileocolic artery

middle colic artery supplies blood to

superior aspect of transverse colon

right colic artery supplies blood to

ascending colon

midgut structures

-Distal duodenum -jejunum -Ileum -Cecum -Appendix -Ascending colon -Proximal 2/3 trasnverse colon

branches of the IMA in the hindgut

-Left colic artery -Sigmoidal arteries -Superior rectal artery

sigmoid arteries supply

sigmoid colon

superior rectal artery supplies

rectum

hindgut structures

-distal 1/3 transverse colon -descending colon -sigmoid colon -upper anal canal

abdominal esophagus

-mechanical digestion and transfer of bolus to the stomach -passes through diaphragm

where does abdominal esophagus pass through the diagram

-esophagus hiatus -lower esophageal sphincter

blood supply to diaphragm

esophageal branch of Left Gastric Artery

Rugae

contraction & expansion of the stomach & increases SA for secretion of gastric juices

Blood Supply of greater curvature of the stomach

right & left gastroomental arteries

blood supply to lesser curvature of the stomach

right and left gastric arteries

blood supply to fundus of the stomach

short gastric arteries (via celiac trunk and splenic artery

small intestine

-breaks down proteins, lipids, carbohydrates and absorption by increasing SA

waht does the small intestine extend from

Pyloric orfice -> ileocecal junction

3 parts of the small intestine

duodenum, jejunum, ileum

what does the duodenum attach to proximally

pyloric sphincter of the stomach

how many parts of the duodenum are there

4 parts -1 is intraperitoneal -3 are retroperitoneal

duodenum

-20-25cm -1st part of small intestine -C-shaped

pancreas relative to duodenum

pancreas punches itself into the C-shape of duodenum

4 parts of the duodenum

-Superior (1st) part) -Descending (2nd) part -Inferior/horizontal (3rd) part -Ascending (4th) part

which part of the duodenum is intraperitoneal

the superior part (level w/ celiac trunk)

2nd (descending) part of duodenum

-retroperitoneal -contains minor & major papilla -contains hepatopancreatic Ampulla of Vater

Minor Papilla

bile, gastric juices, and enzymes enter here from pancreas

Major Papilla

drains into descending portion of duodenum

3rd (inferior/horizontal) part of duodenum

-retroperitoneal -inferior to SMA -passes anterior to abdominal aorta and IVC

4th (ascending part of duodenum)

-retroperitoneal -attaches to suspensory ligament of duodenum that hangs the duodenal fissure -contains duodenojejunal flexure

1st and 2nd part of duodenum is supplied by

anterior & posterior SUPERIOR pancreaticduodenal arteries

3rd and 4th part of duodenum is supplied by

Anterior & posterior INFERIOR pancreaticduodenal arteries

What branches off the SMA to supply the pancreas

1. posterior inferior pancreaticduodenal artery 2. Anterior inferior pancreaticduodenal artery

Ileum location

-in the right lower quadrant of abdomen

Ileum ends at

the iliocecal junction

Jejunum location

left upper quadrant

Jejunum begins at

the duodenojejunal flexure

where does the 4th portion of the duodenum fold down

duodenojejunal flexure

Mesentery proper

-contains blood supply & VD -double folding of peritoneum

Jujunum BS

jejunal arteries > arterial arcades > vasa recta

Ileum BS

Ileal arteries > arterial arcades > vasa recta

what do the jujunal arteries and ileal arteries branch off of

SMA

Vasa recta and arcades in the Jejunum

not as many vasa recta & large arcades

vasa recta and arcades in the ileum

more vasa recta and smaller arcades