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MD3002 > oesophagus, stomach and duodenum > Flashcards

oesophagus, stomach and duodenum Flashcards

1
Q

what type of epithelium is found in the oesophagus

A

stratified squamous epithelium with submucosal mucous glands and smooth muscle

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2
Q

where does the oesophagus pass through the diaphragm

A

right crus of the diaphragm at t10 (7th costal cartilage), just left of the midline

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3
Q

what is the arterial, venous and lymphatic supply of the abdominal oesophagus

A

left gastric artery

left gastric vein to portal vein

nodes along the left gastric artery and coeliac nodes

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4
Q

what is the innervation of the abdominal oesophagus

A

anterior vagal trunk derived from the left vagus and a posterior vagus from the right vagus
via the oesophageal plexus

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5
Q

describe the portocaval anastomosis

A

submucosal veins in the oesophagus form an anastomosis between the middle and lower thirds

the middle thirds drains to the azygous vein -> SVC and the lower thirds drains to the portal vein

portal hypertension may lead to blood escaping into the azygous vein

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6
Q

what are the components of the physiological sphincter

A
  1. contraction of right crus
  2. tonic contraction in the circular layers of smooth muscle in the lower oesophagus
  3. oblique entry of the oesophagus into the stomach

under vagal control

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7
Q

what is the Z line

A

transition from squamous epithelium to columnar epithelium

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8
Q

where is the cardiac orifice

A

40-43 cm from the incisors

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9
Q

what are the 4 parts of the stomach

A

cardia
fundus
body
pylorus ( antrum and canal)

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10
Q

what makes up the pyloric sphincter

A

thickened circular muscle in the pyloric region that controls the outflow of stomach contents

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11
Q

what is magenstrasse

A

mucosal rugae that help directs fluids from fundus to pylorus

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12
Q

what does the stomach do

A

receives and stores food and fluid

adds more fluid, acid and enzymes to create chyme and carry out digestion

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13
Q

what is the arterial supply of the stomach

A

derived from the coeliac trunk

left gastric artery arises from the coeliac trunk
the right gastric artery arises from the hepatic artery which is a branch of the coeliac trunk

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14
Q

which artery supplies the lower thirds of the oesophagus and upper right part of the stomach

A

left gastric artery. it arises from the coeliac trunk and goes to the oesophagus and then down along the lesser curvature

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15
Q

which artery supplies the lower right part of the stomach

A

right gastric artery

arises from the hepatic artery at the pylorus and runs left along the lesser curvature

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16
Q

what do the short gastric arteries arise from

A

the splenic artery at the hilum of the spleen and pass forward into the gastrosplenic ligament to supply the fundus

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17
Q

what are the branches of the splenic artery

A

short gastric arteries, left gastro-omental artery (left gastro-epiploic artery)

greater pancreatic artery dorsal pancreatic artery,

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18
Q

what artery supplies the lower part of the greater curvature

A

right gastro epiploic artery

from the gastro duodenal branch of the hepatic artery

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19
Q

what artery supplies the upper part of the greater curvature

A

left gastro epiploic artery

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20
Q

where is the gastro duodenal artery

A

posterior to the first part of the duodenum

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21
Q

where do the stomach veins drain to

A

portal circulation

the left and right gastric veins drain directly to the portal vein

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22
Q

where do the short gastric veins and the left gastro epiploic veins drain to

A

splenic vein

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23
Q

what does the right gastro epiploic vein drain into

A

the superior mesenteric vein which goes to the portal vein

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24
Q

where does lymph from the stomach drain to

A

coeliac nodes located around the coeliac trunk

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25
Q

what is the innervation of the stomach

A

sympathetic fibres T5-9 via the greater splanchnic nerves via the coeliac plexus

parasympathetic fibres from the right and left vagus nerves

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26
Q

what is a vagotomy

A

vagal trunks are cut to reduce gastric acidity and prevent ulcers. however also affects motility. Now nerves are cut more selectively to maintain sphincteric function

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27
Q

what forms the stomach bed

A

posterior wall of the lesser sac and retroperitoneal structures between it and the post abdominal wall:

 part of the
diaphragm (left crus), the
spleen, the left suprarenal
gland and upper pole of the
left kidney
Inferiorly: body and tail of
pancreas, transverse
mesocolon, left colic flexure
and the splenic artery
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28
Q

how long is the small intestine

A

6-7 metres long

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29
Q

how long is the duodenum

A

20-25 cm long, adjacent to the head of the pancreas. mainly retoperitoneal

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30
Q

what is the function of the duodenum

A

continued digestion, esp. fats absorption

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31
Q

where does the duodenum receive bile and pancreatic ducts

A

major and minor duodenal papilla

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32
Q

where is the first part of the duodenum (superior part)

A

begins
at the pylorus and runs upward, backward and to the right, starting on the transpyloric plane at the level of the 1st lumbar vertebra

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33
Q

where is the second part of the duodenum (or descending part)

A

runs vertically downward in front of the hilum of the right kidney on the right side of the 2nd and 3rd lumbar vertebrae

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34
Q

where is the 3rd part of the duodenum ( horizontal part)

A

runs horizontally to the left on the subcostal plane, passing in front of the vertebral column at L3 and following the lower margin of the head of the pancreas

35
Q

where is the 4th part of the duodenum (ascending part)

A

runs upward and to the left to the duodenojejunal flexure at L2

usually at the same level as the duodenal cap

36
Q

where is the major duodenal papilla aka ampulla of Vater

A

halfway down the medial border of the duodenum

37
Q

what are the anterior relations of the superior part of the duodenum

A

The quadrate lobe of the liver and the gallbladder

38
Q

what are the posterior relations of the superior part of the duodenum

A

The lesser sac (first inch only), the gastroduodenal artery, the bile duct and portal vein, and the inferior vena cava

39
Q

what are the superior relations of the superior part of the duodenum

A

The entrance into the lesser sac (the epiploic foramen)

40
Q

what are the inferior relations of the superior part of the duodenum

A

The head of the pancreas

41
Q

where is the anterior aspect of the superior part of the duodenum

A

in the peritoneal cavity, therefore ulcers could open into the cavity causing peritonitis and gas under the diaphragm, but the posterior part is retroperitoneal

42
Q

what are the anterior relations of the descending part of the duodenum

A

The gallbladder (gall stone ileus) and the right lobe of the liver (at its start), the transverse colon, and the coils of the small intestine

43
Q

what are the posterior relations of the descending part of the duodenum

A

The hilum of the right kidney and the right ureter

44
Q

what are the lateral relations of the descending part of the duodenum

A

The ascending colon, the right colic flexure, and the right lobe of the liver

45
Q

what are the medial relations of the descending part of the duodenum

A

The head of the pancreas, the bile duct, and the main pancreatic duct

46
Q

what are the anterior relations of the horizontal part of the duodenum

A

The root of the mesentery of the small intestine, the superior mesenteric vessels contained within it, and coils of jejunum

47
Q

what are the posterior relations of the horizontal part of the duodenum

A

The right ureter, the right psoas muscle, the inferior vena cava, and the aorta

48
Q

what are the superior relations of the horizontal part of the duodenum

A

The head of the pancreas

49
Q

what are the inferior relations of the horizontal part of the duodenum

A

Coils of jejunum

50
Q

what are the posterior relations of the ascending part of the duodenum

A

The left margin of the aorta and the medial border of the left psoas muscle

51
Q

what are the anterior relations of the ascending part of the duodenum

A

The beginning of the root of the mesentery and coils of jejunum

52
Q

where is the paraduodenal recess

A

where the duodenal junction gains a mesentery

hernias are possible but rare

53
Q

what is the arterial supply of the upper half of the duodenum

A

supraduodenal and gastroduodenal branches of the hepatic artery

54
Q

what is the arterial supply of the lower half of the duodenum

A

superior mesenteric artery (midgut) that gives the Inferior pancreaticoduodenal artery, which quickly divides into anterior and posterior branches

55
Q

what do the superior and inferior pancreaticoduodenal arteries form

A

anterior and posterior anastomotic arches

56
Q

which artery is at risk with posterior ulcers of the 1st part of the duodenum

A

gastroduodenal artery

57
Q

what is the venous drainage of the duodenum

A

The superior pancreaticoduodenal vein drains into the portal vein; the inferior vein joins the superior mesenteric vein

58
Q

what is the lymph drainage of the duodenum

A

Coeliac and SM nodes

59
Q

what is the nerve supply of the duodenum

A

sympathetic greater (T5 to T9) and lesser splanchnic (T10 and 11) nerves and parasympathetic (vagus) nerves via the coeliac and superior mesenteric plexuses

60
Q

where does the oesophagus start

A

c6 as a continuation of the pharynx

61
Q

what is the supply of the upper oesophagus

A

Arterial supply from inferior thyroid arteries
Venous drainage to brachiocephalic veins
Nerve supply from branches of the vagus nerves (recurrent laryngeal nerves)
Lymphatics drain to deep cervical nodes

62
Q

what is the supply of the middle oesophagus

A

Arterial supply direct from thoracic aorta and bronchial arteries
Venous drainage to azygos system (systemic)
Nerve supply from the oesophageal plexus (vagus and sympathetic)
Lymphatics drain to tracheobronchial nodes

63
Q

what is the supply of the middle oesophagus

A

Arterial supply from left gastric artery
Venous drainage to left gastric veins and therefore to portal vein
Nerve supply from branches of the oesophageal plexus (vagus and sympathetic)
Lymphatics drain to left gastric and coeliac nodes

64
Q

what are the 4 oesophageal constrictions

A

Upper oesophageal sphincter 17cm
Arch of aorta
Left main bronchus at 28cm
Diaphragm at 43cm

65
Q

what are the 3 layers of stomach muscle from outside to in

A

longitudinal
circular
oblique

66
Q

list the 6 sphincters of the digestive tract

A 
UES
LES
Pyloric sphincter
ileocaecal valve
IAS
EAS
67
Q

What are the four layers of the GI tract

A

mucosa
submucosa
muscularis
serosa

68
Q

what are the 3 layers of the mucosa

A

epithelia
lamina propria
muscularis mucosa

69
Q

what is gallstone ileus

A

small bowel obstruction caused by a gallstone in the small intestine

70
Q

what nerve goes to the pyloric sphincter

A

nerve of Laterget

71
Q

at what vertebral level is the umbilicus

A

L3 and L4 vertebrae

72
Q

what is the angular incisure

A

a notch at the inferior end of the lesser curvature

marks the change between the body and the pylorus

73
Q

what arteries supply the fundus

A

short gastric

74
Q

what artery supplies the upper part of the greater curvature

A

left gastroomental which is a branch of the splenic artery

75
Q

what artery travels through the gastrosplenic ligament

A

left gastroomental

76
Q

what artery supplies the inferior part of the greater curvature

A

right gastroomental which arises from the gastroduodenal branch of the hepatic artery

77
Q

what is the right gastric artery a branch of

A

the hepatic artery

78
Q

what are the short gastric arteries a branch of

A

the splenic artery

79
Q

where does the stomach refer pain to

A

lower chest and epigastrium

80
Q

what are the branches of the gastroduodenal artery

A

the right gastroepiploic artery

the superior pancreaticoduodenal artery which gives a posterior and superior branch

81
Q

what are the branches of the SMA

A 
inferior pancreaticoduodenal arteries 
intestinal arteries
ileocolic
right colic
middle colic
82
Q

what is the greater splanchnic nerve

A

travels from the thorax to the abdomen and supplies the foregut
T5-9
modulates the enteric nervous system and contributes to the coeliac plexus

83
Q

what is the lesser splanchnic nerve

A

modulates the enteric NS of the midgut

84
Q

what is the blood supply of the greater omentum

A

gastroepiploic arteries

MD3002 (56 decks)

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