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MD3002 - GI Anatomy > Oesophagus, Stomach and Duodenum > Flashcards

Oesophagus, Stomach and Duodenum Flashcards

1
Q

What is the function of the oesophagus?

A

transport food and fluid to stomach by peristaltic waves

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2
Q

What are the borders/margins of the oesophagus

A

starts in the midline as the continuation of the pharynx at C6; inferior border of cricoid cartilage

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3
Q

Where does the oesophagus descend between?

A

between trachea and vertebral column

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4
Q

Where does the oesophagus enter the thorax?

A

behind trachea, with the arch of the aorta to its left in the superior mediastinum

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5
Q

Where does the oesophagus enter the abdominal cavity?

A

T10, slightly left of the midline

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6
Q

What are the 4 non-pathological constrictions of the oesophagus?

A
  • upper oesophgeal sphincter - level C6
  • Arch of aorta - T4
  • Left main bronchus
  • Diaphragm - T10
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7
Q

What feature is related to the oesophagus anteriorly but not a constriction?

A

left atrium

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8
Q

What sphincter lies between the oesophagus and pharynx?

A

cricopharyngeal sohincter

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9
Q

What is the significance of oesophgeal constrictions?

A
  • more likely to cause blockage
  • Hinder the passage of instruments
  • Slow down the oassage of caustic substances - causing more damage
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10
Q

Indicate the:

  • muscle type
  • swallowing
  • arterial supply
  • venous drainage
  • innervation
  • lymphatic drainage

of the superior 1/3 of the oesophagus

A
  • striated
  • voluntary and rapid
  • inferior thyroid artery
  • brachiocephalic veins
  • vagus (recurrent laryngeal)
  • deep cervical
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11
Q

Indicate the:

  • muscle type
  • arterial supply
  • venous drainage
  • innervation
  • lymphatic drainage

of the middle 1/3 of the oesophagus

A
  • mix
  • Aorta, brachiocephalic aa.
  • Azygos
  • Oesophgeal plexus (vagus + T1-4, greater splanchnic nerve)
  • Trachaeobronchial
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12
Q

Indicate the:

  • muscle type
  • swallowing
  • arterial supply
  • venous drainage
  • innervation
  • lymphatic drainage

of the inferior 1/3 of the oesophagus

A
  • smooth
  • involuntary and slow
  • left gastric artery, left inferior phrenic artery
  • left gastric vein, oesophgeal vv.
  • oesophgeal plexus (vagus + T1-4, greater splanchnic nerve)
  • left gastric, coeliac
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13
Q

What is the shortest part of the oesophagus?

A

abdominal oesophagus (lower 1/3)

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14
Q

Where does the abdominal oesophagus travel?

A
  • from the oesophageal haitus to the cardiac notch of the stomach
  • passes through the right crus of diaphragm at T10
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15
Q

How is the abdominal oesophagus attached to the oesophgeal hiatus?

A

phreno-oesophgeal ligament

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16
Q

What is the arterial supply of the abdominal oesophagus?

A

left gastric artery, a branch of the coeliac trunk

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17
Q

What veins drain the abdominal oesophagus?

A
  • left gastric, short gastric veins drain to portal vein
  • oesopheal veins drain to azygos system
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18
Q

What is the nerve supply of the abdominal oesophagus?

A
  • parasympathetic from vagus
  • sympathetic from greater splanchnic (T5-T()
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19
Q
A

green = left gastric artery

red = oesophgeal veins

blue = left gastric vein

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20
Q

What is the lymphatic drainage of the abdominal oesophagus?

A
  • left gastric lymph nodes
  • celiac lymph nodes
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21
Q

What is the main reflux mechanism of the lower oesophgeal sphincter? (major and minor)

A

Major

  • circular smooth muscle fibres
  • right crus of diaphragm

Minor:

  • Clasp fibres
  • oblique entry of the oesophagus into the stomach
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22
Q

What is the Z-line?

A

gastro-oesophgeal junction is usually identified by a circumfenential ‘zigzag’ line between the pale pink oesophgeal squamous epithelium above and the red columnar epithelium below

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23
Q

What is Barrett’s Oesophagus?

A

pathological replcament of oesophgeal squamous epithelium by gastric columnar epithelium

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24
Q

What is the stomach?

A

a muscular sac

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25
Q

Where is the stomach located?

A

epigastric, left hypogastric (hypochondiral) and umbilical regions

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26
Q

What is Labbe’s triangle?

A

location where the sotmach is normally in contact with the abdominal wall

  • left costal arch
  • lower border of liver
  • horizontal liver connecting the tips of right anf left 9th CC
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27
Q

What are the main functions of the stomach?

A
  • Temporary storage of ingested food
  • Mechanical breakdown of solid food
  • Chemical digestion of proteins
  • Mixes the food with gastric secretions to form chyme
  • Regulation of the rate of passage of the chyme to the duodenum
  • Secretion of
    • acid to aid digestion and absorption of iron
    • intrinsic factor for vitamin B12 absorption
    • gut hormones
  • Microbial defence
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28
Q

What are the 4 main parts of the stomach and the other defining features?

A
  • Cardia: surrounds the opening of the esophagus into the stomach
  • Fundus: area above the level of the cardiac orifice (usually filled with air)
  • Body
  • Pyloric part
    • Pyloric [Gastric] antrum
    • Pyloric canal
  • Greater curvature
  • Lesser curvature
  • Anterior surface
  • Posterior surface
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29
Q

What is the stomach related to anteriorly?

A
  • Anterior abdominal wall
  • Left costal margin
  • Diaphragm
  • Left pleura & lung (via diaphragm)
  • Left lobe of the liver
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30
Q

What is the stomach related to posteriorly?

A
  • Lesser sac
  • Spleen
  • Upper pole of left kidney
  • Left suprarenal gland
  • Pancreas
  • Splenic artery
  • Transverse colon
  • Transverse mesocolon
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31
Q

What does the muscular wall of the stomach contain?

A

longitudnal, circular and oblqiue fibres (3 layers of muscle)

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32
Q

What forms the pyloric sphincter and what is its function?

A
  • circular fibres in the pyloric region
  • controls the outflow of gastric contents into the duodenum
33
Q

Where does the coeliac trunk originate?

A

upper border of L1 vertebra

34
Q

What are the 3 major branches of the coeliac trunk?

A
  • left gastric artery
  • common hepatic artery
  • splenic artery
35
Q

Describe the course of the left gastric artery and what it supplies

A
  • direct branch of coeliac trunk
  • runs along the lesser curvature
  • supplies abdominal oesophagus, proximal lesser curvature and adjacent body of the stomach
36
Q

Describe the course of the right gastric artery and what does it supply

A
  • branch of the common hepatic artery
  • runs along the lesser curvature
  • Supplies the distal lesser curvature and body of the stomach
37
Q

Describe the course of the left gastro-epiplogloic (gastro-omental) artery and what does it supply

A
  • runs in the gastro-splenic (gastro-lienal) ligament
  • left side of the greater and adjacent body of the stomach
38
Q

Describe the course of the right gastro-epiplogloic (gastro-omental) artery and what does it supply

A
  • branch of gastroduodenal branch of the common hepatic artery
  • right side of greater curvature and adjacent body of the stomach
39
Q

Describe the course of the short gastric arteries and what they supply

A
  • branches of the splenic artery
  • runs in the gastro-splenic (gastro-lienal) ligament
  • the fundus of the stomach and abdominal oesophagus
40
Q
A

blue = left gastric artery

green = right gastric artery

41
Q
A

blue = left gastro-epiplogloic (gastro-omental) artery

green = right gastro-epiplogloic (gastro-omental) artery

red = short gastric arteries

42
Q
A
43
Q

How do the veins of the stomach run?

A

parallel to the arteries

44
Q

Where do the left and right gastric veins drain into

A

portal vein

45
Q

where do the Short gastric and left gastroepiploic veins drain into

A

splenic vein –> portal vein

46
Q

Where does the right gastroepiploic vein drains into

A

the superior mesenteric vein –> portal vein

47
Q

What is the sympathetic nerve supply of the stomach?

A
  • greater splanchnic nerve(T5-9)
  • coeliac plexus
  • pain & vasomotor
48
Q

What is the parasympathetic nerve supply of the stomach?

A
  • vagal trunks (posterior = R; Anterior = L)
  • Secretion
  • Motility
  • Afferents for emesis
49
Q

Where does each zone of the stomach drain into lymphatics?

A
  • Zone I (inferior gastric) –> subpyloric and omental nodes
  • Zone II (splenic) –> pancreaticosplenic nodes
  • Zone III (superior gastric) –>superior gastric nodes
  • Zone IV (hepatic) –> suprapyloric nodes
50
Q

Where does lymph from the stomach intially pass through

A

gastric and gastroepiploic arteries

eventually drained to coeliac nodes

51
Q

What is a hiatus hernia?

A

Herniation of the stomach through the diaphragm into the mediastinum

52
Q

Structures against which the posteroinferior surface of the stomach lies is called the bed of stomach. What lies within the bed of the stomach?

A

− Left crus of the diaphragm

− Spleen

− Left suprarenal gland

− Upper pole of the left kidney

− Body & tail of pancreas

− Transverse mesocolon

− Left colic (splenic) flexure

− Splenic artery

53
Q

Who are hiatus hernias more common in

A

eldery and the obese

54
Q

What are the 2 main types of hiatus hernia and what is their prevalence

A

− Sliding hernia (>90%)

− Para-oesophageal (rolling) hernia

55
Q

What symptoms are associated with hiatus hernia?

A

asymptomatic

gastro-oesophgeal reflux

56
Q

What can a para-oesophfeal hernia cause?

A

obstruction and/or ischaemia of the herniated stomach

57
Q

What is the treatment of a symptomatic sliding hernia?

A

managing assoicated gastro-oesophgeal reflux, which may require anti-reflux surgery

58
Q

Where is pain from the lower oesophagus referred to?

A

retrosternal area

59
Q

Draw a diagram of each type of hiatus hernia

A
60
Q

What is the longest part of the alimentery canal?

A

small intestine; extending from the pylorus to the ileocaecal valve

61
Q

What mostly occurs in the small intestine

A

food digestion and absorption

62
Q

What are the 3 parts of the small intestine?

A

duodenum, jejunum, ileum

63
Q

What are the 4 parts of the duodenum?

A
  • Superior (Ampulla or duodenal cap)
  • Descending
  • Horizontal
  • Ascending
64
Q

What is part 1 of the duodenum?

A

intraperitoneal (covered with peritoneum from all sides)

65
Q

What are parts 2-4 of the duodenum?

A

retroperitoneal (behind the peritneum)

66
Q

What ducts open into the duodenum?

A

common bile duct and pancreatic ducts

67
Q

What are the functions of the duodenum?

A

digestion (especially fats)

absorption

68
Q

Describe the course of the duodenum

A
  • Transpyloric plane: Lower L1
  • Descend, right of the midline from L2 to L3
  • Horizontal at L3
  • Ascend to L2
  • Duodenojejunal flexure (ligament of Treitz)
69
Q

What is the minor duodenal papilla?

A

opening of the accessory oancreatic duct

70
Q

What is the major duodenal papilla?

A

common opening between the common bile and pancreatic ducts. Boundary between midgut and foregut

71
Q
A

blue = minor duodenal papilla

red = major duodenal papilla

72
Q

What is the blood supply of the duodenum up the the major duodenal papilla (ampulla od Vater)?

A
  • derived from foregut
  • supplied by branches of the common hepatic artery
    • gastroduodenal artery
    • supraduodenal artery
    • superior pancteaticoduodenal artery (posterior and anterior)
73
Q

What is the blood supply of the duodenum distal to the major duodenal papilla?

A

supplied by the midgut

  • supplied by the inferior pancreaticoduodenal artery (anterior and posterior)
74
Q

Where does the lymph of the duodenum drain to?

A

superior mesenteric or pancreoticoduodenal and pyloric nodes

75
Q

Where do the veins of the duodenum drain to?

A

to hepatic portal vein, either directly or indirectly through the superior mesenteric and splenic veins

76
Q

What artery is at risk of posterior ulcers in the duodenum?

A
  • gastroduodenal artery in the first part of the duodenum
77
Q

What is the SNS and PSNS supply of the duodenum?

A
  • Sympathetic fibres via greater splanchnic nerves (T5-9)
  • Parasympathetic fibers from vagus via the coeliac & superior mesenteric plexuses
78
Q

What are the 3 main types of bariatric surgery?

A
  • gastric bypass
  • gastric sleeve or vertical gastrectomy
  • adjustable gastric banding

MD3002 - GI Anatomy (11 decks)

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