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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
What is the origin of the duodenum?
Immediately following pyloric region of the stomach
26
At which position is the first part of the duodenum found?
Transpyloric plane
27
What does the 2nd part of the duodenum wrap around?
Pancreas to the RHS of the midline
28
How does the biliary tree make its way through the pancreas and into duodenum?
Goes through head of pancreas and enters into 2nd part of duodenum
29
What is the pathway of the 3rd part of the duodenum?
Crosses back over IVC and aorta
30
What is the pathway of the 4th part of the duodenum?
Ascents to duodenojujenal flexure (LHS of midline)
31
Distinguish between the intra and retoperitoneal parts of the duodenum
1st part: intraperitoneal | 2nd, 3rd, 4th: retroperitoneal
32
Where do the superior mesenteric artery and vein cross over the duodenum?
3rd part
33
What are other names for the 1st to 4th part of the duodenum?
1: superior 2: descending 3: inferior 4: ascending
34
What is the arterial supply of the duodenum?
Superior half: superior pancreatoduodenal branches (from gastroduodenal artery - coeliac origin) Inferior half: inferior pancreatoduodenal branches (from superior mesenteric origin)
35
What is the nerve supply of the duodenum?
Superior: Celiac plexus at T12 Inferior: Superior mesenteric plexus at L1
36
What is the venous drainage of the duodenum?
Superior: Direct to portal vein Inferior: SMV
37
What is the lymphatic drainage of the duodenum?
Superior: Pre-aortic coeliac nodes at T12 Inferior: Pre-aortic superior mesenteric nodes at L1
38
What is the ampulla of vater?
Union of common bile duct and main pancreatic duct
39
What is meant by an ampulla?
Swelling in the tube where 2 ducts meet
40
What is another name for ampulla of vater?
Hepatopancreatic ampulla
41
What is the major duodenal papilla? What is its purpose?
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
What enters through the minor duodenal papilla?
Accessory pancreatic duct
43
What is the arterial supply of the midgut?
Branches of SMA
44
What is the venous drainage of the midgut?
SMV
45
What is the nerve supply to the midgut?
Superior mesenteric plexus
46
What are the lymphatics of the midgut?
Pre-aortic nodes at L1 (superior mesenteric nodes)
47
Where is pain from the midgut referred to?
Umbilical region
48
Describe the structure of the small intestine?
Long, thin, muscular tube (6m long)
49
What is the function of the small intestine?
Bulk of digestion occurs here
50
What is the small intestine divided into?
Jejunum (proximal 2/5th) | Ileum (distal 3/5th)
51
What is the small intestine suspended from the body wall with?
Mesentery
52
Describe the mesentery of the small intestine. What does it allow?
Fan-shaped folds of peritonuem enclosing the gut tube. Allows ingress/egress of vessels, nerves, and lymphatics
53
Describe the main identifying difference between the jejunum and ileum.
Arterial arcade patterning J: 1 or 2 arcade with long branches I: More arcades with many short branches
54
What is the arterial supply of the small intestine?
Branches of SMA - Jejunal arteries - Ileal arteries
55
What is the ANS nerve supply of the small intestine?
Superior mesenteric plexus at L1
56
What is the venous drainage of the small intestine?
SMV
57
What is the lymphatic drainage of the small intestine?
Pre-aortic superior mesenteric nodes at L1
58
What are the two flexures of the large intestine? Which is positioned lower?
Right colic/hepatic flexure (lower) | Left colic/splenic flexure
59
What are the functions of the large intestine?
- Absorb water and electrolytes | - Store undigested material until expelled by the body
60
What are the 4 general features of the large intestine?
Haustra Appendices epiploicae Teniae coli Appendix
61
What are haustra?
Saculations of the wall of the large intestine
62
What are Appendices epiploicae?
Fatty tags that can get inflamed, which mimics appendicitis. None on small intestine.
63
What are teniae coli?
Longitudinal muscles collected into 3 bands, continuous with the smooth muscle of the small intestine
64
In what regions is the large intestine found?
In all regions except the umbilical
65
List where each of the components of the large intestine are found in the different regions of the abdomen
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
What is the arterial supply of the caecum/appendix?
Caecal and appendicular arteries from the ileocolic artery
67
What is the arterial supply of the ascending colon?
Right colic artery
68
What is the arterial supply of the proximal 2/3 transverse colon?
Middle colic and marginal
69
Which branches that supply the large intestine are given off from the SMA?
Iliocolic artery Right colic artery Middle colic artery Marginal artery
70
What is the arterial supply of the distal 1/3 of the transverse colon?
Marginal and left colic artery
71
Descending colon arterial supply
Left colic artery
72
Sigmoid colon arterial supply
Sigmoid artery
73
Branches of the IMA that supply the large intestine
Marginal Left colic Sigmoid
74
What is the marginal artery?
The anastamotic point between the superior and inferior mesenteric arteries
75
What portion of the colon often becomes muscularised?
Descending/sigmoid
76
What is the function of the rectum?
Final storage depot for digestive material
77
At which level does the sigmoid colon become the rectum?
At S3 vertebral level
78
Where does the rectum pierce the pelvic diaphragm?
AT the tip of coccyx
79
What does the rectum become after piercing the pelvic diaphragm?
Anal canal
80
Describe the relationship between the rectum and the peritoneum for each third.
Superior: Covered in visceral peritoneum on anterior and lateral sides Middle: Peritoneum on anterior surface only Inferior: Infraperitoneal
81
What is the arterial supply of the rectum?
Sup: Superior rectal branches of IMA Mid: Middle rectal branch of internal iliac Inferior: Inferior rectal branch of internal pudendal
82
Describe the venous drainage of the rectum
Superior rectal vein - IMV - portal vein | Mid. and inferior rectal vein - internal iliac - common iliac - IVC
83
What is portal-systemic anastomosis important in?
Cases of hypertension
84
What is the ANS nerve supply of the rectum?
Proximal 1/3: inferior mesenteric plexus | Distal 2/3: inferior hypogastric plexus
85
What are the lymphatics of the rectum?
Proximal 1/3: to pre-aortic nodes at L3 | Distal 2/3: to internal iliac nodes
86
At what position is the portal vein formed?
At L1 transpyloric plane
87
What is the parasympathetic nerve supply to the gut?
``` Vagus nerve (CN X) Pelvic splanchnic nerves S2-4 ```
88
What is the sympathetic nerve supply to the gut?
Thoracic, lumbar, and sacral splanchnic nerves from T5-L2 sympathetic ganglia
89
What does the autonomic nervous system control in the gut?
Viscera, glands, blood vessels Smooth muscle Non-conscious control Motor and sensory
90
What do splanchnic nerves control?
They are specifically visceral so go straight to organs
91
State the plexus, sympathetic and parasympathetic supply to the foregut.
Coeliac plexus Sym: Greater splanchnic T5-9 Para: Vagus [X]
92
State the plexus, sympathetic and parasympathetic supply to the midgut
Superior mesenteric plexus Sym: Lesser splanchnic T10-T11 Para: Vagus [X]
93
State the plexus, sympathetic and parasympathetic supply to the hindgut
Inferior mesenteric/superior hypogastric plexus | Sym: Lumbar/sacral splanchnic L1-2/S2-4
94
Where is pain referred back to?
The origin spinal levels of the sympathetic supply via afferent fibres and then via the dorsal root (along with somatic afferents).
95
Is there a specific point of reference for the nerves in the gut? What is a consequence of this?
NO | Pain is spread around the corresponding dermatome
96
Where does pain in the foregut get referred to?
Epigastric region
97
Where does pain in the midgut get referred to?
Umbilical region
98
Where does pain in the hindgut get referred to?
Suprapubic region
99
What happens to the appendix during appendicitis?
Appendix becomes enflamed
100
Where does pain get referred to during appendicitis?
Afferent sympathetic fibres refer back to T10-11 dermatomes
101
What kind of pain is experienced during initial appendicitis? Where?
Broad diffuse pain experienced around umbilical region
102
What happens when the appendix becomes so enflamed that it is in contact and starts pressing on parietal peritoneum of body wall?
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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