Oesophagus, Stomach and Duodenum Part 2

Question 1

Describe the lymphatic drainage of the stomach

Answer 1

Initial:

• pancreaticosplenic nodes
• gastric nodes
• pancreaticoduodenal nodes
• pyloric nodes
• gastro-omental

Secondary:

• mesenteric nodes
• coeliac (all end up drained here)

Question 2

Describe the nerve supply of the stomach and its role

Answer 2

• sympathetics from greater splanchnic nerve T5-9
• coeliac plexus
• controls pain and vasomotor
• parasympathetics from vagus (anterior and posterior trunks)
• increases secretion, motility, relaxes sphincters
• controls afferents for emesis

Question 3

Where is pain from the stomach referred to?

Answer 3

epigastric region and lower chest

Question 4

What is a hiatus hernia and the types?

Answer 4

• herniation of stomach through diaphragm into mediastinum
• sliding hernia (>90%)
• para-oesophageal hernia

Question 5

What are the symptoms of a hiatus hernia?

Answer 5

• pain retrosternally
• can be asymptomatic
• associated with heartburn
• para-oesophageal can cause ischaemia or obstruction

Question 6

What are the benefits of cutting the vagus nerve and what are the possible side effects?

Answer 6

• cutting the vagus can reduce acidity and prevent gastric ulcers (as long as the branches to pyloric sphincter are preserved to maintain motility)
• side effects can be feeling full and sphincteric dysfunction

Question 7

What are the 3 parts of the small intestines?

Answer 7

• duodenum
• jejunum
• ileum

Question 8

What are the 4 parts of the duodenum?

Answer 8

• superior
• descending
• horizontal
• ascending
• part 1: intraperitoneal
• parts 2-4: retroperitoneal

Question 9

Describe the position of the duodenum

Answer 9

• transpyloric plane: lower L1
• descends right of midline from L2-3
• horizontal at L3
• ascends to L2

Question 10

What are the papillae in the duodenum for and what are the 2 types?

Answer 10

• papillae create union between biliary system and pancreatic enzymes being produced by exocrine pancreas
• minor duodenal papilla: opening of accessory pancreatic duct
• major duodenal papilla: common opening of common bile and pancreatic ducts and boundary between fore- and mid gut

Question 11

Describe the arterial supply of the foregut duodenum

Answer 11

• supplied by branches of the common hepatic artery:
• gastroduodenal artery
• supraduodenal artery
• superior pancreaticoduodenal artery

Question 12

Describe the arterial supply of the midgut duodenum

Answer 12

• supplied by branches of the superior mesenteric artery:

* inferior pancreaticoduodenal artery

Question 13

Describe the venous and lymph drainage of the duodenum

Answer 13

• lymph vessels drain to superior mesenteric or pancreaticoduodenal and pyloric nodes
• veins drain to hepatic portal vein, directly or indirectly through superior mesenteric and splenic veins

Question 14

What is the nerve supply of the duodenum?

Answer 14

• sympathetics by greater splanchnic nerves

- parasympatheics from vagus and coeliac and superior mesenteric plexuses