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GIT Anatomy > Lower GIT > Flashcards

Lower GIT Flashcards

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1
Q

Describe the division of regions/quadrants of the GIT

A

Regions:
- right and left hypochondrium, and epigastric regions - separated into each other by midclavicular plane
- divided from lumbars/umbilicals by subcostal plane
- divided from iliacs/pubic region by intertubercular plane
- quadrants divided by transumbilical and sagittal planes

Note: McBurney’s point: start of appendix
Note 2: umbilicus location changes with weight

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2
Q

Recall the layers of peritoneum

A

Recall the two layers of peritoneum
- parietal
- visceral
- mesentery is a continuation of visceral
Note some organs are intraperitoneal i.e. surrounded by both layers, while other lies retroperitoneal.

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3
Q

Describe the retroperitoneal space and list the organs within

A
  • The retroperitoneal space sits between the peritoneum and posterior abdominal wall (psoas major and quadratus lumborum), and extends from T12 and 12th rib to sacrum and iliac crest
  • suprarenal glands
  • aorta
  • duodenum
  • pancreas
  • ureters
  • colon - ascending and descending
  • oesophagus
  • rectum
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4
Q

Describe some peritoneal relationships

A
  • omentum is connected to stomach - lesser and greater omentum
  • mesentery has two main portions
    • mesocolon - transverse and sigmoid
    • mesentery of small intestine
  • peritoneal ligaments, thicking of pertitoneum, help keep organs in place
    • falciform
    • hepatogastric
    • hepatoduodenal
    • gastrosplenic
    • gastrocolic
    • gastrophrenic
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5
Q

DESCRIBE THE LESSSER OMENTUM AND OMENTAL BURSA

A
  • lesser omentum is made of peritoneum
    • contains? hepato-duodenal ligament and hepato-gastric ligament
  • omental bursa or omental sac, lesser sac
  • inferior: stomach, duodenum, transverse colon, right colic/hepatic flexure, right kidney, R adrenal gland
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6
Q

Describe the position (and changes) of liver

A
  • the diaphragmatic surface fits under the dome of the diaphragm
  • ascends with expiration, descends with inspiration
  • occupies both of right hypogastric and epigastric regions
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7
Q

Describe the anterior surface of the liver and key structures

A
  • irregular, wedge-like shape
  • covered by peritoneum
  • diaphragmatic i.e. superior anterior surface, is convex, fits under the dome of the diaphragm
  • key features include:
    • diaphragm
    • coronary ligament
    • L triangular ligament
    • falciform ligament
    • R and L lobes
    • round ligament, recall left-over from fetal circulation
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8
Q

Describe the visceral surface of the liver and key structures

A
  • has four margins: anterior, posterior, left and right
  • portia hepatis
    • hepatic artery proper
    • hepatic portal vein
    • hepatic ducts
  • key features include:
    • R and L lobes
    • caudate lobe
    • quadrate lobe
    • IVC
    • bare area - uncovered by peritoneum, rougher texture
    • portia hepatis: cystic duct, hepatic artery proper, hepatic portal vein
    • R triangular ligament
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9
Q

Describe the biliary tree

A
  • from hepatocytes
    • biliary canaliculi
    • interlobular bile duct
    • R and L hepatic ducts
    • common hepatic duct (into which drains cystic duct)
    • common bile duct (into which drains pancreatic duct) through head of pancreas
    • ampulla of Vater, surrounded by sphincter of Oddi
    • inserts into greater duodenal papilla
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10
Q

Describe the differences between jejunum and ileum

A
  • jejunum mainly occupies upper quadrants
  • ileum mainly occupies lower quadrants
  • jejunum has longer vasa recta
  • ileum has larger arterial arcades
  • jejunum has thicker mucosa/submucosa
  • ileum has aggregated lymphoid nodules, jujunum does not

jejunum is deeper red, ileum is paler pink
- calibre is similar: 2-4 vs 2-3 cm
- wall is thick and heavy vs thin and light
- vascularity is greater vs less
- vasa recta is long vs short
- arcades: few short loops vs many short loops
- less mesenteric fat vs more
- circular folds are large, tall, and closely packed vs low distal and sparse – completely absent in distal part
- few lymphoid nodules or Peyer’s patches vs many

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11
Q

Describe the features of the large intestine

A
  • has five parts
    • caecum (where ileum opens into)
    • appendix - taenia coli can help identify
    • colon: taeniae coli (three bands of smooth muscle: omental (only along transverse), mesocolic (posterior) and free(anterior)), haustra, omental appendage
    • rectum
    • anal canal
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12
Q

Describe the various positions of the appendix and its clinical significance

A
  • end of appendix can sit in several positions including
    • preileal
    • postileal
    • prececal
    • retrocecal
    • subcecal
    • pelvic
    • promonteric
  • clinical significance: size and position can vary — influences where pain is perceived
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13
Q

Describe the supply territory of the superior mesenteric

A
  • midgut: duodenum, jejunum, ileum, large intestine to transverse colon
  • several branches
    • jujunal
    • ileal
    • vasa recta–> arterial arcades
    • ileocolic
    • colic branch
    • anterior and posterior caecal
    • appendicular
    • right colic
    • middle colic
    • inferior pancreaticoduodenal
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14
Q

Describe the supply territory of the inferior mesenteric

A
  • hindgut: part of transverse, descending and sigmoid colon, rectum
  • branches include:
    • left colic
      • asc and desc branches
    • sigmodial aa
    • superior rectal
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15
Q

Describe teh lymphatic draingage of the lower GIT

A
  • many including
    • paracolic
    • superior mesenteric
    • inferior mesenteric
    • intermediate colic
    • ileocolic
    • lateral aortic
    • epicolic
    • appendicular
    • coeliac
  • everything ends up in celiac
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16
Q

Describe the features of the rectum

A
  • note adjacent to prostate: DRE
  • divided from intestine by rectosigmoid junction
  • three lateral curves, created by rectal folds
  • expanded to form rectal ampulla
  • lacks taenia coli, omental appendices and haustra
  • key features include: rectal ampulla, folds, jucntion
17
Q

Conrast the rectum and anal canal

A
  • anal canal is not anus
  • rectum and anal canal divided by pectinate line
  • above pectinate line
    • inferior mesenteric artery supplies
    • mainly superior rectal drains; also inferior mesenteric and portal
    • internal iliac lymph nodes
    • visceral motility and sensation - no pain on incision
    • columnar epithelial mucosa
  • below pectinate line
    • internal iliac artery
    • mainly inferior rectal vein drainage; also internal ilaic and IVC
    • superficial inguinal lymph nodes
    • somatic motor/sensory – does have pain
    • squamous epithelial mucosa
  • note: internal and extenal sphincter muscle
    • extenal is skeletal
      • deep
      • superficial
      • subcutaneous
    • internal is smooth
  • note levator ani near rectum
18
Q

Describe blood inflow to liver and outflow

A

Inflow
- (Hepatic) portal vein (75%)
- Drains blood from stomach, intestines, pancreas and spleen
- O2-poor nutrient-rich blood. **portal vein drains blood into the liver not from the liver.
- Hepatic artery (25%)
- Branch of the celiac trunk from the descending aorta.
- O2 rich blood.
- Outflow
- Hepatic veins (R and L) drain blood from the liver into the inferior vena cava.

19
Q

List veins of GIT

A
  • note also L gastric straight to portal
  • g omental v into inferior mesenteric V
20
Q

Describe the consequences of the portal systemic anastomoses

A
  • portal vein and tributaries have no valves
  • portal hypertension leads to venous enlargement or varices at portosystemic anastomoses
  • three main presentations
    • Oesophageal varices at the gastroesophageal junction
    • Caput medusae at the umbilicus
    • Haemorrhoids at the anorectal junction (can have without PH)
21
Q

Descrieb teh roles of sympathetic and parasympathetic innervation of the GIT

A
  • sympathetic which inhibits contraction muscle excitability
  • PSY which enhances muscle excitability
  • head, neck, thorax and body wall: paravertebral ganglia (Sympathetic trunk)
  • abdomen and pelvis: paravertebral ganglia, coeliac, SMG, IMG
22
Q

Describe sources of sympathetic innervation of the lower GIT

A
  • greater splanchnic nerve
    • celiac ganglian
    • stomach, liver, ?intestine, adrenal glands and kidneys
  • lesser
    • superior mesenteric ganglion
    • small intestine
  • lumbar splanchnic
    • inferior mesenteric ganglion
    • large intestine
23
Q

Describe sources of enteric innervation

A
  • System: mechanical and chemical receptors –> enteric reflex
  • myenteric plexus: muscle motility
  • submucous plexus: secretion and absorption
24
Q

Describe Hirschprung’s disease

A
  • congenital disease
  • intestinal obstruction shortly after birth
  • chronic constipation, swelling of abdomen
  • absence of ganglion cells at Meissner’s/submucosal plexus

GIT Anatomy (5 decks)

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