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M: DS > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Which abdominal components are not contained within the abdominal cavity?

A

Oes and rectum

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2
Q

Which region is referred pain generally referred to?

A

Epigastric, umbilical, pubic regions

Quadrant system also used

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3
Q

What does the celiac trunk split into?

A

Left gastric, splenic, common hepatic

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4
Q

Is the celiac trunk short or long?

A

Short

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5
Q

Where does the celiac trunk come off the abdominal aorta?

A

At T12

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6
Q

Where does the superior mesenteric artery come off the abdominal aorta?

A

At L1

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7
Q

Where does the inferior mesenteric artery come off the abdominal aorta?

A

At L3

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8
Q

What is the arterial supply of the foregut?

A

Branches of celiac axis

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9
Q

What is the venous drainage of the foregut?

A

Portal vein

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10
Q

What is the nerve supply to the foregut?

A

Celiac plexus at T12

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11
Q

What are the lymphatics of the foregut?

A

Pre-aortic nodes at T12 (Celiac nodes)

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12
Q

Where is pain in the foregut referred to?

A

Epigastric region

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13
Q

What is the general region where the stomach is located?

A

Epigastric region to the left of the midline.

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14
Q

At which position is the fundus located?

A

Ribs 5/6

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15
Q

At which position does the oes enter the stomach?

A

Costal cartilage of ribs 7/8

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16
Q

At which position is the pylorus located?

A

L1 vertebral level on the transpyloric plane

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17
Q

What are the three muscle layers in the wall of the stomach?

A
  • Outer longitudinal
  • Middle circular
  • Inner oblique
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18
Q

What is the special feature that the inner wall has?

A

Many rugae to increase surface area and expandability

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19
Q

Where on the stomach does the lesser omentum attach?

A

Lesser curvature

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20
Q

Describe the pyloric valve

A

Thickened region of muscle controlling flow of contents out of stomach

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21
Q

What is the arterial supply of the stomach ultimately from?

A

Coeliac trunk

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22
Q

What is the arterial supply of the lesser curvature?

A 
Left gastric (coeliac trunk)
Right gastric (common hepatic)
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23
Q

What is the arterial supply of the greater curvature?

A

Left gastro-omental (splenic)

Right gastro-omental (gastroduodenal

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24
Q

What is the arterial supply of the fundus?

A

Short gastric

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25
Q

What is the origin of the duodenum?

A

Immediately following pyloric region of the stomach

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26
Q

At which position is the first part of the duodenum found?

A

Transpyloric plane

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27
Q

What does the 2nd part of the duodenum wrap around?

A

Pancreas to the RHS of the midline

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28
Q

How does the biliary tree make its way through the pancreas and into duodenum?

A

Goes through head of pancreas and enters into 2nd part of duodenum

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29
Q

What is the pathway of the 3rd part of the duodenum?

A

Crosses back over IVC and aorta

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30
Q

What is the pathway of the 4th part of the duodenum?

A

Ascents to duodenojujenal flexure (LHS of midline)

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31
Q

Distinguish between the intra and retoperitoneal parts of the duodenum

A

1st part: intraperitoneal

2nd, 3rd, 4th: retroperitoneal

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32
Q

Where do the superior mesenteric artery and vein cross over the duodenum?

A

3rd part

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33
Q

What are other names for the 1st to 4th part of the duodenum?

A

1: superior
2: descending
3: inferior
4: ascending

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34
Q

What is the arterial supply of the duodenum?

A

Superior half: superior pancreatoduodenal branches (from gastroduodenal artery - coeliac origin)
Inferior half: inferior pancreatoduodenal branches (from superior mesenteric origin)

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35
Q

What is the nerve supply of the duodenum?

A

Superior: Celiac plexus at T12
Inferior: Superior mesenteric plexus at L1

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36
Q

What is the venous drainage of the duodenum?

A

Superior: Direct to portal vein
Inferior: SMV

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37
Q

What is the lymphatic drainage of the duodenum?

A

Superior: Pre-aortic coeliac nodes at T12
Inferior: Pre-aortic superior mesenteric nodes at L1

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38
Q

What is the ampulla of vater?

A

Union of common bile duct and main pancreatic duct

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39
Q

What is meant by an ampulla?

A

Swelling in the tube where 2 ducts meet

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40
Q

What is another name for ampulla of vater?

A

Hepatopancreatic ampulla

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41
Q

What is the major duodenal papilla? What is its purpose?

A

A mound that enters through wall of descending duodenum. Controls flow of bile (from liver) and pancreatic juice from pancreas into the duodenum via the sphincter of Oddi.

42
Q

What enters through the minor duodenal papilla?

A

Accessory pancreatic duct

43
Q

What is the arterial supply of the midgut?

A

Branches of SMA

44
Q

What is the venous drainage of the midgut?

45
Q

What is the nerve supply to the midgut?

A

Superior mesenteric plexus

46
Q

What are the lymphatics of the midgut?

A

Pre-aortic nodes at L1 (superior mesenteric nodes)

47
Q

Where is pain from the midgut referred to?

A

Umbilical region

48
Q

Describe the structure of the small intestine?

A

Long, thin, muscular tube (6m long)

49
Q

What is the function of the small intestine?

A

Bulk of digestion occurs here

50
Q

What is the small intestine divided into?

A

Jejunum (proximal 2/5th)

Ileum (distal 3/5th)

51
Q

What is the small intestine suspended from the body wall with?

52
Q

Describe the mesentery of the small intestine. What does it allow?

A

Fan-shaped folds of peritonuem enclosing the gut tube. Allows ingress/egress of vessels, nerves, and lymphatics

53
Q

Describe the main identifying difference between the jejunum and ileum.

A

Arterial arcade patterning
J: 1 or 2 arcade with long branches
I: More arcades with many short branches

54
Q

What is the arterial supply of the small intestine?

A

Branches of SMA

  • Jejunal arteries
  • Ileal arteries
55
Q

What is the ANS nerve supply of the small intestine?

A

Superior mesenteric plexus at L1

56
Q

What is the venous drainage of the small intestine?

57
Q

What is the lymphatic drainage of the small intestine?

A

Pre-aortic superior mesenteric nodes at L1

58
Q

What are the two flexures of the large intestine? Which is positioned lower?

A

Right colic/hepatic flexure (lower)

Left colic/splenic flexure

59
Q

What are the functions of the large intestine?

A
  • Absorb water and electrolytes

- Store undigested material until expelled by the body

60
Q

What are the 4 general features of the large intestine?

A

Haustra
Appendices epiploicae
Teniae coli
Appendix

61
Q

What are haustra?

A

Saculations of the wall of the large intestine

62
Q

What are Appendices epiploicae?

A

Fatty tags that can get inflamed, which mimics appendicitis. None on small intestine.

63
Q

What are teniae coli?

A

Longitudinal muscles collected into 3 bands, continuous with the smooth muscle of the small intestine

64
Q

In what regions is the large intestine found?

A

In all regions except the umbilical

65
Q

List where each of the components of the large intestine are found in the different regions of the abdomen

A

Caecum/appendix: Right groin
Ascending colon: Right flank
Hepatic flexure: Right hypochondrium (inferior to liver)
Transverse colon: Epigastric region
Splenic flexure: Left hypochondrium (anterior to spleen)
Descending colon: Left flank
Sigmoid colon: Left groin

66
Q

What is the arterial supply of the caecum/appendix?

A

Caecal and appendicular arteries from the ileocolic artery

67
Q

What is the arterial supply of the ascending colon?

A

Right colic artery

68
Q

What is the arterial supply of the proximal 2/3 transverse colon?

A

Middle colic and marginal

69
Q

Which branches that supply the large intestine are given off from the SMA?

A

Iliocolic artery
Right colic artery
Middle colic artery
Marginal artery

70
Q

What is the arterial supply of the distal 1/3 of the transverse colon?

A

Marginal and left colic artery

71
Q

Descending colon arterial supply

A

Left colic artery

72
Q

Sigmoid colon arterial supply

A

Sigmoid artery

73
Q

Branches of the IMA that supply the large intestine

A

Marginal
Left colic
Sigmoid

74
Q

What is the marginal artery?

A

The anastamotic point between the superior and inferior mesenteric arteries

75
Q

What portion of the colon often becomes muscularised?

A

Descending/sigmoid

76
Q

What is the function of the rectum?

A

Final storage depot for digestive material

77
Q

At which level does the sigmoid colon become the rectum?

A

At S3 vertebral level

78
Q

Where does the rectum pierce the pelvic diaphragm?

A

AT the tip of coccyx

79
Q

What does the rectum become after piercing the pelvic diaphragm?

A

Anal canal

80
Q

Describe the relationship between the rectum and the peritoneum for each third.

A

Superior: Covered in visceral peritoneum on anterior and lateral sides
Middle: Peritoneum on anterior surface only
Inferior: Infraperitoneal

81
Q

What is the arterial supply of the rectum?

A

Sup: Superior rectal branches of IMA
Mid: Middle rectal branch of internal iliac
Inferior: Inferior rectal branch of internal pudendal

82
Q

Describe the venous drainage of the rectum

A

Superior rectal vein - IMV - portal vein

Mid. and inferior rectal vein - internal iliac - common iliac - IVC

83
Q

What is portal-systemic anastomosis important in?

A

Cases of hypertension

84
Q

What is the ANS nerve supply of the rectum?

A

Proximal 1/3: inferior mesenteric plexus

Distal 2/3: inferior hypogastric plexus

85
Q

What are the lymphatics of the rectum?

A

Proximal 1/3: to pre-aortic nodes at L3

Distal 2/3: to internal iliac nodes

86
Q

At what position is the portal vein formed?

A

At L1 transpyloric plane

87
Q

What is the parasympathetic nerve supply to the gut?

A 
Vagus nerve (CN X)
Pelvic splanchnic nerves S2-4
88
Q

What is the sympathetic nerve supply to the gut?

A

Thoracic, lumbar, and sacral splanchnic nerves from T5-L2 sympathetic ganglia

89
Q

What does the autonomic nervous system control in the gut?

A

Viscera, glands, blood vessels
Smooth muscle
Non-conscious control
Motor and sensory

90
Q

What do splanchnic nerves control?

A

They are specifically visceral so go straight to organs

91
Q

State the plexus, sympathetic and parasympathetic supply to the foregut.

A

Coeliac plexus
Sym: Greater splanchnic T5-9
Para: Vagus [X]

92
Q

State the plexus, sympathetic and parasympathetic supply to the midgut

A

Superior mesenteric plexus
Sym: Lesser splanchnic T10-T11
Para: Vagus [X]

93
Q

State the plexus, sympathetic and parasympathetic supply to the hindgut

A

Inferior mesenteric/superior hypogastric plexus

Sym: Lumbar/sacral splanchnic L1-2/S2-4

94
Q

Where is pain referred back to?

A

The origin spinal levels of the sympathetic supply via afferent fibres and then via the dorsal root (along with somatic afferents).

95
Q

Is there a specific point of reference for the nerves in the gut? What is a consequence of this?

A

NO

Pain is spread around the corresponding dermatome

96
Q

Where does pain in the foregut get referred to?

A

Epigastric region

97
Q

Where does pain in the midgut get referred to?

A

Umbilical region

98
Q

Where does pain in the hindgut get referred to?

A

Suprapubic region

99
Q

What happens to the appendix during appendicitis?

A

Appendix becomes enflamed

100
Q

Where does pain get referred to during appendicitis?

A

Afferent sympathetic fibres refer back to T10-11 dermatomes

101
Q

What kind of pain is experienced during initial appendicitis? Where?

A

Broad diffuse pain experienced around umbilical region

102
Q

What happens when the appendix becomes so enflamed that it is in contact and starts pressing on parietal peritoneum of body wall?

A

Somatic sensory supply is activated and pain is now felt as acute and localised to lower right quadrant.

M: DS (29 decks)

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