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Yr 2 - GI & Metabolism > SDL - Hindgut, Liver, Gallbladder > Flashcards

SDL - Hindgut, Liver, Gallbladder Flashcards

1
Q

What vertebral level does IMA arise?

A

L3

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2
Q

What vessels contribute to the formation of the marginal artery?

A

SMA = marginal, right colic arteries

IMA = left colic, sigmoid arteries

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3
Q

Where do aortic aneurysms commonly occur?

A

In abdomen around level of origin of IMA

As the aneurysm enlarges, it often compresses the inferior mesenteric artery

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4
Q

Why does gradual obstruction of IMA not impair gut function?

A

Due to the collateral circulation provided by the marginal artery

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5
Q

What is no longer present after the rectosigmoid junction?

A

Taenia coli and appendices epiploicae

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6
Q

What is a sigmoid volvulus?

A

Obstruction of the colon due to twisting around the sigmoid mesocolon.

Can lead to chronic constipation, bowel ischaemia

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7
Q

Where does the rectum run from/to?

A

From the rectosigmoid junction to the ano-rectal junction

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8
Q

Where is the ano-rectal junction?

A

Lies at the level of the pelvic floor

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9
Q

What is found in the rectum?

A

Rectal valves

Three lateral curves, each marked on the interior by a transverse fold or valve. Two of these folds project from the left with the one between them projecting from the right.

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10
Q

Describe the peritoneal attachments of the rectum

A

Superior third = anterior and lateral sides covered

Middle third = only anterior

Inferior third = subperitoneal

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11
Q

What vessels supply the rectum?

A

Superior, middle and inferior rectal arteries

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12
Q

Where does the superior rectal artery arise?

A

IMA

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13
Q

Where does the middle rectal artery arise?

A

Internal iliac

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14
Q

Where does the inferior rectal artery arise?

A

Internal pudendal

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15
Q

What is the definition of a portal vein?

A

Blood vessel that takes blood from one capillary bed to a second prior to it entering the vena cava and returning to the heart.

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16
Q

Where are there portal veins?

A
  • Towards to liver

- Around the pituitary gland

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17
Q

How is drainage from foregut irregular?

A

No coeliac vein and no gastroduodenal vein

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18
Q

Where do veins of midgut drain into?

A

SMV

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19
Q

What does the SMV unite with?

A

SMV unites with the splenic vein posterior to the neck of the pancreas to form the portal vein

N.B. it is named portal vein above and superior mesenteric vein below the level of entry of the splenic vein, but the two represent a single continuous trunk.

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20
Q

Where does the portal vein run?

A

In the free edge of the lesser omentum

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21
Q

What does the right gastric vein drain into?

A

Portal vein

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22
Q

What does the left gastric vein drain into?

A

Splenic vein

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23
Q

What do the short gastric veins drain into?

A

Splenic vein

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24
Q

What does the right gastroepiploic vein drain into?

A

SMV

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25
Q

What does the left gastroepiploic vein drain into?

A

Splenic vein

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26
Q

What do the superior pancreaticoduodenal veins drain into?

A

SMV

27
Q

What is purpose of portal circulation?

A

To allow blood carrying recently digested chyme to be ‘processed’ by the liver prior to entering the general circulation.

28
Q

Where do the oesophageal veins drain?

A

Azygous system

29
Q

Where are the site of anastomosis between the portal and systemic venous systems?

A
  • The oesophageal veins
  • Anterior abdominal wall
  • Ano-rectal junction
30
Q

Why is knowledge of the lymphatic drainage of the gastrointestinal tract important?

A

Spread of metastasising cancer cells

31
Q

Where do lymph vessels draining the GI tract pass back to?

A

Pass back along the course of the arteries to lymph nodes that lie in front of the aorta at the origins of the coeliac, superior and inferior mesenteric arteries.

These are called the coeliac, superior and inferior mesenteric groups of lymph nodes.

32
Q

What is the exception to the rule of this lymphatic drainage system?

A

Rectum

Although the major artery of the rectum is the superior rectal branch of the inferior mesenteric artery, lymph also follows the middle rectal artery to the internal iliac lymph nodes.

33
Q

What are the coeliac, superior mesenteric and inferior mesenteric lymph nodes also termed?

A

Pre-aortic nodes

They drain into each other from below upwards, the coeliac group itself draining into the cisterna chyli.

34
Q

What lymphatic channel originates from the cisterna chyli?

A

Thoracic duct

35
Q

What are Peyer’s patches?

A

Areas of lymphoid tissue which are located within the walls of the small intestine.

36
Q

In which layers of the gut wall are the intrinsic (myenteric) nerve plexuses located?

A

In the muscularis propria, between the submucosa and the serosa or adventitia

37
Q

How do most of the autonomic fibres to the gut travel?

A

Via the coeliac plexus which is located around the coeliac trunk

38
Q

How do parasympathetic fibres to the hindgut travel?

A

Via the inferior hypogastric (pelvic) plexus.

39
Q

Where do parasympathetic fibres to the hindgut originate?

A

From the sacral segments of the spinal cord

40
Q

What does the coeliac plexus receive its parasympathetic input from?

A

The 2 vagus nerves

Aids digestion

41
Q

Where does the coeliac plexus receives its sympathetic input from?

A

Splanchnic nerves

Limits digestion

42
Q

How do the splanchnic nerves arise? Where do they enter abdomen?

A

From the sympathetic chain. Enter the abdomen via the aortic hiatus.

43
Q

Where would referred pain from the foregut, midgut and hindgut be felt?

A

Foregut –> epigastric (the upper central region of the abdomen)

Midgut –> umbilical region

Hindgut –> hypogastric or pubic region

44
Q

Where is the hypogastric region?

A

A region of the abdomen located below the umbilical region

45
Q

Where is pain from the call bladder referred to?

A

Shoulder

46
Q

Name the structures that pass through the porta hepatis

A

Hepatic ducts (left and right)
HPV
Hepatic arteries

47
Q

What is located on the posterior surface of the liver?

A

IVC

48
Q

Where do the hepatic veins (usually 3) drain into?

A

IVC

49
Q

What factors contribute to the support of the liver?

A
  • Hepatic veins
  • Falciform ligament
  • Triangular ligament
50
Q

How many anatomical lobes does the liver have?

A

4 - right, left, caudate, quadrate

51
Q

What are the right and left lobes of the liver separated by?

A

Falciform ligament

52
Q

Is the right of left lobe of the liver larger?

A

Right

53
Q

Where are the caudate and quadrate lobes of the liver located?

A

Postero-inferior aspect

54
Q

These anatomical lobes of the liver don’t correspond with functional lobes.

Functionally, how are the right and leeft lobes defined?

A

According to their blood supply

Each functional lobe is drained by its own hepatic duct and has its own venous drainage. The functional lobes are further subdivided into segments, each with distinct blood supply and biliary drainage.

55
Q

What is the right functional lobe of the liver supplied by?

A

The right branch of the hepatic artery and the right branch of the portal vein

56
Q

What is the left functional lobe of the liver supplied by?

A

The left branch of the hepatic artery and the left branch of the portal vein

57
Q

What is the function of the gallbladder?

A

Store and concentrate bile

58
Q

Where is bile made? Describe its route

A

Liver

It is collected into microscopic canaliculi. These will eventually drain into the left and right hepatic ducts. These join (usually at the porta hepatis) to form the common hepatic duct. This in turn is joined by the cystic duct to form the common bile duct.

59
Q

Describe the position of structures within the free edge of the lesser omentum

A

Anterior left = HA
Anterior right = BD
Posterior = HPV

60
Q

Where does the common bile duct run after it leaves the edge of the lesser omentum?

A

Posterior to the duodenum and head of pancreas, to form the hepatopancreatic ampulla wth the main pancreatic duct.

61
Q

What is the hepatopancreatic ampulla (of Vater) and where is the sphincter of Oddi?

A

Dilation where the BD and MPD unite, it is surrounded by the hepatopancreatic sphincter (of Oddi). A smooth muscle sphincter so is under control of the ANS.

62
Q

If a gallstone became lodged at the sphincter of Oddi, which other organ would be affected?

A

Pancreas

63
Q

Why do patients with biliary obstruction appear yellow? Such patients also have pale faeces and dark urine. Why?

A

Bile is reabsorbed in to the blood stream and deposited where there is low pressure ie surface of the skin. Pale faeces are due to the lack of bile entering the GI tract and therefore colouring the faeces. As it is in the blood stream it is filtered by the kidney darkening the urine.

64
Q

What is the blood supply of the gall bladder? Where does it come from?

A

Cystic artery. Some variation, but mostly from the right hepatic artery

Yr 2 - GI & Metabolism (51 decks)

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