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MD3002 Anatomy > Oesophagus stomach and duodenum > Flashcards

Oesophagus stomach and duodenum Flashcards

1
Q

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

A
  • Cricopharyngeal (upper oesophageal) sphincter
  • Arch of aorta
  • Left main bronchus
  • Diaphragm
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2
Q

What can constrictions cause?

A
  • Blockade
  • Hinder passage of instruments
  • Slow down the passage of caustic substances -> more damage
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3
Q

What level is the upper oesophageal sphincter?

A

C6

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4
Q

What level is the arch of the aorta?

A

T4

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5
Q

What level is the diaphragm?

A

T10

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6
Q

What chamber of the heart is the oesophagus related to anteriorly?

A

Left atrium

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7
Q

What berve(s) are the middle and lower thirds of the oesophagus innervated by?

A
  • Oesophageal plexus (which is):
    Vagus
    T1-4
    Splanchnic
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8
Q

Where is the abdominal oesophagus located?

A

Oesophageal hiatus to the cardiac orifice of the stomach

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9
Q

What does the oesophagus pass through specifically at T10?

A

Right crus of the diaphragm

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10
Q

What is the abdominal oesophagus tethered to the margins of the oesophageal hiatus by?

A

Phrenooesophageal ligament

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11
Q

What is the arterial supply of the abdominal oesophagus?

A

Branches of the left gastric artery, a branch of the coeliac trunk

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12
Q

What is the abdominal oesophagus drained by?

A
  • Short gastric -> left gastric -> portal vein

- Oesophageal veins -> azygos system

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13
Q

What is the nerve supply of the abdominal oesophagus?

A
  • Parasympathetics from vagus

- Sympathetics from greater splanchnic

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14
Q

What is the lymph drainage of the abdominal oesophagus?

A
  • Left gastric lymph nodes

- > Celiac lymph nodes

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15
Q

What is a sphincter?

A
  • Circular muscle fibres around a hollow organ

- Serves to guard or close an opening

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16
Q

What is the “High Pressure Zone”

A
  • Pressure gradient between abdomen and thorax

- Around lower 2 - 4 cm of the oesophagus

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17
Q

What are the 2 major and multiple minor anti-reflux mechanisms?

A
  • Circular smooth muscle fibers in the lower oesophagus

- Right crus of diaphragm

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18
Q

What are the minor anti-reflux factors?

A
  • Clasp fibres

- Oblique entry of the oesophagus into the stomach

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19
Q

What are clasp fibres?

A
  • Circular muscle fibres from lesser to gretaer curvature

- Lie just below gastro-oesophageal junction

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20
Q

What is achalasia?

A
  • When ganglion cells in the myenteric plexus of the distal oesophagus and gastro-oesophageal junction are reduced or absent
  • Lower oesophageal sphincter fails to open up during swallowing
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21
Q

What is Barrett’s oesophagus?

A

Pathological replacement of oesophageal squamus epithelium by gastric columnar epithelium

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22
Q

What does the gastro-oesophageal junction look like?

A
  • Circumferential ‘zigzag’ line

- Between pale pink oesophageal squamous epithelium above and the red columnar epithelium below

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23
Q

What is the stomach?

A
  • Dilated muscular sac
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24
Q

Where is the stomach located in terms of abdominal regions?

A
  • Epigastric
  • Left hypogastric
  • Partially umbillical regions
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25
Q

What is Labbe triangle?

A
  • The location where the stomach is normally in contact with the abdominal wall
  • Left costal arch
  • Lower border of liver
  • Horizontal line connecting the tips of right and left 9th costal cartilages
  • Varibale
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26
Q

What are the functions of the stomach?

A
  • Storage
  • Digestion
  • Secretion
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27
Q

What are the 4 parts of the stomach?

A
  • Cardia
  • Fundus
  • Body
  • Pyloric part
    antrum + canal
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28
Q

What are the 3 layers of muscle in the stomach?

A
  • Longitudinal
  • Circular
  • Oblique
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29
Q

What forms the pyloric ssphincter?

A
  • Circular fibres in the pyloric sphincter

- Controls outflow of gastric contents into duodenum

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30
Q

What is the arterial supply of the foregut?

A

Coeliac trunk

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31
Q

What is the arterial supply of the midgut?

A

Superior mesenteric artery

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32
Q

What is the arterial supply of the hindgut?

A

Inferior mesenteric artery

33
Q

What are the 3 branches of the celiac trunk?

A
  • Common hapaticc artery
  • Left gastric artery
  • Splenic artery
34
Q

What is the arterial supply of the stomach?

A
  • All derived from coeliac trunk
  • Left gastric (direct branch)
  • Right gastric (branch of common hepatic)
35
Q

What is the arterial supply of the stomach?

A
  • All derived from coeliac trunk
  • Left gastric (direct branch)
  • Right gastric (branch of common hepatic)
  • Left gastroepiploic (branch of splenic)
  • Right gastroepiploic (branch of the gastroduodenal branch of the common hepatic artery)
  • Short gastric arteries (branches of splenic)
36
Q

Where does the right gastric artery run/supply?

A
  • Branch of common hepatic
  • Runs along lesser curvature
  • Distal lesser curvature and adjacent body of the stomach
37
Q

Where does the right gastric artery run/supply?

A
  • Branch of common hepatic
  • Runs along lesser curvature
  • Distal lesser curvature and adjacent body of the stomach
38
Q

Where do the short gastric arteries run?

A
  • Branches of the splenic arteries
  • Runs in the gastro-splenic (gastro-lienal) ligament
  • The fundus of the stomach
39
Q

What do the veins of the stomach follow?

A

They run parallel to the arteries of the stomach

40
Q

What do the left and right gastric veins drain into?

A

The hepatic portal vein

41
Q

What do the short gastric and left gastroepiploic veins drain into?

A

The splenic vein -> Hepatic portal vein

42
Q

What does the right gastroepiploic vein drain into?

A

The superior mesenteric vein -> Hepatic portal vein

43
Q

What is lymh from the stomach initially passed to?

A

Nodes that lie along the arteries

44
Q

What is lymph eventually drained by in the stomach?

A

The coeliac nodes

45
Q

What is the can be the consequence of retrograde lymph flow from coeliac nodes?

A
  • Spread of cancer from coelic nodes to hepatic lymph nodes (stomach to liver)
  • Enlarged hepatic lymph nodes might compress on bile duct and patient may present with jaundice
46
Q

What is the sympathetic nerve supply to the stomach?

A
  • Greater splanchnic nerve (T5-9)
  • Coeliac plexus
  • Pain and vasomotor
47
Q

What is the parasympathetic nerve supply to the stomach?

A
  • Vagal trunk
  • Increase secretion
  • Increase motility, relax sphincters
  • Afferents for emesis
48
Q

What do the parasympathetics from the vagal trunks and sympathetics from the splanchnic nerve (T5-9) form?

A

A plexus

49
Q

What is pain carried by?

A

The sympathetics, referred to epigastric region and lower chest

50
Q

What is general sensation (nausea, vomitting, general discumfort) carried by?

A

Parasympathetics

51
Q

What is a hiatus hernia?

A

Herniation of the stomach through the diaphragm into the mediastinum

52
Q

What groups are ore suseptible to a hiatus hernia?

A

Elderly and obese

53
Q

Where is pain from the lower oesophagus referred to?

A

Retrosternal area

54
Q

What are the 2 types of hiatus hernia?

A
  • Sliding hernia (>90%) all in thoracic cavity

- Para-oesophageal (rolling) hernia most in thoraic cavity

55
Q

What can para-oesophageal hernias cause?

A
  • Obstruction and/or ischaemia of the herniated stomach

- May be asymptomatic or be associated with symptoms of gastro-oesophageal reflux

56
Q

How much milk can a newborn’s stomach contain?

A

30 - 60 ml

57
Q

What is the benefit of cutting the vagus supply to the stomach?

A
  • Reduces gastric acidity and prevents ulcers
58
Q

What are the three types of vagotomy operations?

A
  • Truncal
  • Selective gastric
  • Selective proximal
59
Q

What are the side-effects of a vagotomy?

A
  • Shphincteric dysfunction

- Fullness

60
Q

What is a selective or highly selective vagotomy?

A
  • Vagus supply is reduced but branches to pyloric sphincter are preserved
  • Reduces acid secretion while maintaining motility
61
Q

What parts of the duodenum are considered retroperitoneal?

A

2 - 4

62
Q

What is the function of the duodenum?

A
  • Digestion (especially of fats) and absorption
63
Q

What is needed in order to absorb and digest fats?

A

Bile

64
Q

What are the 4 parts of the duodenum?

A
  • Superior (ampulla or duodenal cap)
  • Descending
  • Horizontal
  • Ascending
65
Q

What level is the 1st part of the duodenum?

A
  • Transpyloric plane: Lower L1
66
Q

Where does the duodenum descend from?

A

L2 to L3

67
Q

Where is the duodenum horizontal?

A

L3

68
Q

Where does the duodenum ascend to?

A

L2

69
Q

What is the duodenojejunal flexure (ligament of Treitz)?

A

Suspends duodenum to diaphragm after it is jejunum

70
Q

What is the minor duodenal papilla?

A

Opening of the accessory pancreatic duct

71
Q

What is the major duodenal papilla?

A
  • Common opening of the common bile and pancreatic ducts

- Boundary between foregut and midgut

72
Q

What artery(s) is the duodenum up to the duodenal papilla supplied by?

A
  • Foregut
  • Branches of common hepatic
    Gatroduodenal artery: supraduodenal artery, superior pancreaticoduodenal artery (ant + post)
73
Q

What is the rest of the duodenum (onwards from ampulla of Vater) supplied by?

A
  • Midgut
  • Branches of superior mesenteric artery
    Inferior pancreaticoduodenal artery (ant + post)
74
Q

Branches of what 2 major arteries achieve collalteral circulation around the duodenum?

A

Coeliac trunk and superior mesenteric artery

75
Q

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

A

Gastroduodenal artery

76
Q

What is the nerve supply of the duodenum?

A
  • Sympathetic fibres via the greater splanchnic nerves (T5-9)
  • Parasympathetics from vagus via the coeliac and superior mesenteric plexuses
77
Q

What is bariatric surgery?

A
  • Surgery to lose weight
78
Q

What are the 3 most common types of bariatric surgery?

A
  • Gastric band
  • Gastric bypass
  • Sleeve gastrectomy

MD3002 Anatomy (14 decks)

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