organs of digestion

Question 1

esophagus course

Answer 1

enters abdomen at esphogeal diaphragmatic hiatus at TV10

abdominal course only 1” enters stomach at TV11

Question 2

esophogeal mesenteries and ligaments

Answer 2

phrenicoesophogeal ligaments- esophagus to diaphragm, allow for independent movement, prevent herniation of esophagus into thorax
mesoesophagus- mesentery of abdominal esophagus

Question 3

esphogeal contrictions

Answer 3

cervical- due to circopharynegeus m
thoracic- due to arch of aorta and left primary bronchus
diaphragmatic- prevents reflux

Question 4

abdominal esophageal blood supply and lymphatics

Answer 4

left gastric a and v

left gastric nodes -> celiac nodes

Question 5

hiatal hernias

Answer 5

herniation of esophagus and/or stomach through esophogeal hiatus
paraesophageal- fundus of stomach herniates through esophageal hiatus anterior to esophagus, may strangulate
sliding- caused by weakening of phrenicoesophageal ligaments allowing cardia and fundus of stomach to herniate into thorax

Question 6

regions of stomach

Answer 6

cardia
fundus
body
pyloric

Question 7

cardia

Answer 7

portion surrounding cardiac orifice

typically TV11

Question 8

fundus

Answer 8

expanded superior portion of stomach

separated from esophagus by cardiac notch

Question 9

body

Answer 9

btwn fundus and pyloric antrum

angular incisure is sharp angulation of lesser curvature where body in continuous w/pyloric region

Question 10

pyloric region

Answer 10

antrum- funnel shaped outflow
pyloric canal- narrow inferior portion
pylorus- portion containing pyloric sphincter, normally locates to the right of midline at LV1/2

Question 11

layers of stomach wall

Answer 11

serosa
muscular layer
mucosa

Question 12

muscular layer of stomach

Answer 12

outer longitudinal layer
inner circular layer (forms pyloric sphincter)
innermost oblique layer

Question 13

mucosa layer of stomach

Answer 13

arranged in folds called gastric folds (rugae)

most prominent along greater curvature and from gastric canal along lesser curvature

Question 14

stomach mesenteries

Answer 14

lesser and greater omentum

Question 15

lymph supply of stomach

Answer 15

gastric nodes along lesser curvature to celiac nodes

gastroepiploic nodes along greater curvature to celiac nodes

Question 16

duodenum

Answer 16

first part of small intestiines 12”

c-shaped courses around head of pancreas

Question 17

duodenum divisions

Answer 17

first (superior)
second (descending)
third (horizontal)
fourth (ascending)

Question 18

superior duodenum

Answer 18

continuous w/pylorus, anterior to LV1
peritonealized assocaiates w/hepatoduoldena ligament
called duodenal bulb bc of thin wall

Question 19

desending duodenum

Answer 19

descends along right side from LV1-3
retropertitoneal
major duodenal papilla (opening for hepatopancreatic ampulla)
minor duodenal papilla (opening for accessory pancreatic duct

Question 20

horizontal duodenum

Answer 20

runs transversly from right to left at LV3

retroperitoneal

Question 21

ascending duodenum

Answer 21

ascends to left of VC from LV3-2
retropertitoneal, except for very end
duodenojejunal flexure
suspensory ligament of treitx supports this flexture

Question 22

anatomical relationships of duodenum- superior

Answer 22

anterior and superior- gallbladder and liver
posterior- common bile duct, gastroduodenal a,
portal v
inferior- head of pancreas
herniation or ulceration of this can erode the gastroduodenal a

Question 23

anatomical relationships of duodenum- descending

Answer 23

anterior- liver, gallbladder, transverse colon, small intestines
posterior- right kidney, renal vessels, IVC
medial- pancreas, gastroduodenal a, bile and pancreatic ducts

Question 24

anatomical relationships of duodenum- horizontal

Answer 24

anterior- superior mesenteric vessels, root of mesentery
posterior- right psoas major, IVC, aorta, right gonadal vessels
superior- head and uncinate process of pancreas

Question 25

anatomical relationships of duodenum- ascending

Answer 25

anterior- root of mesentery, small intestines | posterior- aorta, left psoas major

Question 26

internal feature so duodenum

Answer 26

villi- folds of mucosa which increase surface area for absorption plica circularis- folds of mucosa and submucosa

Question 27

stomach bed

Answer 27

``` diaphragm spleen left kidney suprarenal gland pancreas transverse colon and transverse mesocolon ```

Question 28

paraduodenal hernias

Answer 28

inconstant folds of peritoneum that surrond the third and fourth parts of the duodenum sometimes small intestines can herniate into paraduodenal fossa created by these folds surgical repair needs to be careful not to injure inferior mesenteric vessels

Question 29

lymphatics of duodenum

Answer 29

anterior to pancreaticoduodenal nodes -> pyloric -> celiac nodes posterior drainage to superior mesenteric nodes

Question 30

jejunoileum

Answer 30

pertionealized 6-7m long jejunum 2/5s of this mostly in LUQ illeum 3/5s mostly RLQ and false pelvis

Question 31

mesentery proper

Answer 31

root- where attached to posterior body wall extends on left from LV2 to right sacroiliac joint crosses duodenum, aorta, IVC, ureter, psoas major, right gonadal vv

Question 32

ilium compared to jejunum

Answer 32

thicker wall due to more mm and wider diameter more plica circulares incresed vascularity and deeper red color less mesenteric fat few peyers patches

Question 33

paralyticileus

Answer 33

obstruction of intestine | can be caused by loss of blood supply

Question 34

lymphatic drainage of jeunoileum

Answer 34

juxta-intestinal nodes -> mesenteric nodes -> superior mesenteric nodes

Question 35

large intestine

Answer 35

cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal

Question 36

external cecum -> rectosigmoidal junction

Answer 36

``` larger diameter then small intestine tenja coli- longitiudinal muscle is incomplete and present as 3 thick bands haustra- sacculations of large intestine caused by tonic contractions of tenja coli omental appendages (fat) ```

Question 37

internal cecum -> rectosigmoidal junction

Answer 37

plica semilunares | mucosa devoid of villi

Question 38

cecum and appendix

Answer 38

peritonealized | RLQ

Question 39

internal cecum

Answer 39

ileal orifice surrounded by superior and inferior ileocolic lips no sphincter around ileal orifice, however contraction of terminal ileum likely prevents reflux

Question 40

appendix

Answer 40

blind ending diverticulum contianing lymphoid tissue usually in a retrocecal position mesoappendix

Question 41

appendicitis

Answer 41

initially referred pain T10 dermatome | once spreads to parietal peritoneum pain localized to McBurney (1/3 from ASIS to umbilicus)

Question 42

lymphatics of cecum and appendixx

Answer 42

ileocolic nodes-> superior mesenteric lymph nodes

Question 43

colon

Answer 43

ascending, transverse, descending, sigmoid, right colic flexure (hepatic) let colic flexure (splenic)- where phrenicocolic lig attaches R/L paracolic gutters

Question 44

ascending colon

Answer 44

``` retroperitoneal anterior- small intestine, greater omentum posterior- posterior body wall, kidney medial- small intestine lateral- transversus abdominis ```

Question 45

transverse colon

Answer 45

``` peritonealized anterior- anterior body wall posterior- transverse mesocolon superior- liver, gallbladder, stomach, spleen inferior- small intestines ```

Question 46

desceding

Answer 46

anterior- small intestine posterior- posterior body wall medial- small intestine lateral- transversus abdominis

Question 47

large intestine lymph

Answer 47

paracolic -> R/middle colic nodes -> superior mesenteric nodes paracolic -> L colic nodes -> inferior mesenteric nodes

Question 48

rectum

Answer 48

rectosigmoidal jnx at SV3 terminates at anal canal 6-8"

Question 49

external rectum features

Answer 49

sacral flexures- follows curvature of sacrum teniae coli spread out as a continuous layer of longitudinal m absence of fatty ormental appendages anorectal flexure- posteroinferior angulation as rectum passes through pelvic diaphragm

Question 50

internal rectum features

Answer 50

transverse rectal folds- 2 left, 1 right, folds of mucosa, submucosa, and m which support fecal mass ampulla- dilated, termina portion of rectum proper, importatn for maintaining fecal continence

Question 51

rectum lymph

Answer 51

pararectal nodes drain along superior rectal a to inferior mesenteric nodes pararectal nodes drain along middle rectal a to internal rectal nodes inferior half to sacral and internal iliac nodes

Question 52

internal anal sphincter

Answer 52

surrounds 2/3s of anal canal sympathetic (L1,2) contracts parasympathetic (S2-4) relaxes

Question 53

external anal sphincter

Answer 53

surronds 2/3s of anal canal | voluntary, innervated by inferior rectal n

Question 54

anal columns

Answer 54

vertical folds of mucosa containing superior rectal vessels

Question 55

anal sinuses

Answer 55

small recesses at base of anal columns

Question 56

anal valves

Answer 56

folds of epithelium connecting caudal ends of rectal column

Question 57

pectinate line

Answer 57

formed by anal valves represents a change in: -venous drainage; superior-> drains to superior and middle rectal vv inferior -> drains to inferior rectal v -lymphatic; superior -> internal iliac nodes, inferior-> superficial inguinal nodes -nerve supply; superior- autonomic, inferior -> somatic - epithelial lining; superior-> typical GI mucous lining, inferior -> stratisfies squamous

Question 58

lymph anus

Answer 58

superior to pectinate line- internal iliac nodes | inferior to pectinate line- superficial inguinal nodes

Question 59

internal hemorroids

Answer 59

usually painless bright red bleeding hypertension, pregnancy, constinpation

Question 60

external hemorroids

Answer 60

usually painful | pregnancy, constipation, increased abdominal pressure