SDL - Stomach, Midgut Flashcards
What are the boundaries of the lesser sac?
Anteriorly - Stomach, lesser omentum
Posteriorly - Pancreas
Superiorly - Liver, diaphragm
Inferiorly - Greater omentum
What type of sphincter is the cardiac orifice?
Physiological
What type of sphincter is the pylorus?
Anatomical
At what vertebral level does the pylorus normally lie? What is this the level of?
L1 - The level of the ‘transpyloric plane’
Where does the stomach receive parasympathetic innervation from?
Vagus nerve
How does the left vagus come to lie anteriorly on the stomach and the right vagus posteriorly?
Rotation of stomach
What is found:
- Left
- Right
- Anteriorly
- Posteriorly
- Superiorly
- Inferiorly
to the stomach?
- Left - Spleen
- Right - Liver
- Anterior - Parietal peritoneum
- Posteriorly - Pancreas
- Superiorly - Diaphragm, oesophagus, lesser omentum
- Inferiorly - Greater omentum
What is a hiatus hernia?
Stomach passing through diaphragm
What does the coeliac trunk supply?
Supplies the foregut and its two derivatives (liver, pancreas) and the spleen
What does the SMA supply?
Passes within the mesentery to supply the midgut
What does the IMA supply?
Runs into the transverse mesocolon to supply the hindgut
What vertebral level does the coeliac trunk emerge?
T12
What is the coeliac plexus?
Lies on each side of the coeliac trunk, forms the “hub” of the autonomic nerve supply to the abdominal viscera.
What are the components of the midgut?
Half way along the second part of duodenum (major duodenal papilla) Jejunum Ileum Caecum Appendix Ascending colon Two thirds of transverse colon
What is Meckel’s diverticulum? What % of the population is it present in?
2%
Bulge in the small intestine, can be present at birth and is vestigial remnant of the vitelline duct
How is the large intestine distinguishable?
- its greater calibre;
- its longitudinal muscle layer which is divided into the three taeniae coli
- the presence of sacculations known as haustra
- the presence of fat-filled tags, the appendices epiploicae, which are present mainly on the ascending, transverse and descending colon.
What is diverticulosis?
Pouching of the colon, usually in the region of the sigmoid colon
What is diverticulitis?
Inflammation on a diverticuli due to some infection probably due to trapped faeces.
What can the posterior wall of the caecum look like?
Its posterior wall may be firmly attached to the posterior wall of the right iliac fossa or, more commonly, separated from it by a retrocaecal fossa which can extend as far up as the liver.
What merges at the root of the appendix?
3 taeniae coli
Where does the appendicular artery arise?
Iliocolic artery
What are symptoms of appendicitis?
Para-umbilical discomfort, accompanied by malaise, and diarrhoea or constipation, temperature
Within 24-48 hours, the pain localises to the right iliac fossa
Why is it dangerous to use laxatives during appendicitis?
Vigorous contraction of the gut wall often ruptures the inflamed appendix, precipitating peritonitis
Where is the site of maximum tenderness during appendicitis?
At McBurney’s point, which is the surface marking of the appendix
This lies at the junction of the lateral one-third with the medial two-thirds of a line joining the anterior superior iliac spine to the umbilicus.
What are the different variations of where the appendix is?
In 65% of adults the appendix is retro-caecal; in 25% it hangs over the pelvic brim.
Where can pus from appendix abscess travel? What pain follows?
Abscess can track upwards in the right paracolic gutter to reach the subphrenic space (between the thoracic diaphragm and liver). Referred pain in the right shoulder ensues.
Why is the colon most easily freed from its lateral side?
Blood vessels approach the colon medially from the midline, lateral resection avoid damaging these blood vessels.
Describe the route of the colon
The ascending colon runs from the right iliac fossa to the hepatic flexure under the right lobe of the liver. From the hepatic flexure, the transverse colon runs almost horizontally to the splenic flexure, invested in its mesentery, the transverse mesocolon. The descending colon, extends from the splenic flexure to the pelvic brim, where it acquires a mesentery (the sigmoid mesocolon) and becomes the sigmoid colon
At what level does the SMA arise?
L1
Where does the SMA descend over?
The 3rd part of the duodenum
What is the first branch of the SMA?
Inferior pancreatico-duodenal artery
Where does the inferior pancreatico-duodenal artery come from?
Gastroduodenal artery
