SDL - Stomach, Midgut

Question 1

What are the boundaries of the lesser sac?

Answer 1

Anteriorly - Stomach, lesser omentum

Posteriorly - Pancreas

Superiorly - Liver, diaphragm

Inferiorly - Greater omentum

Question 2

What type of sphincter is the cardiac orifice?

Answer 2

Physiological

Question 3

What type of sphincter is the pylorus?

Answer 3

Anatomical

Question 4

At what vertebral level does the pylorus normally lie? What is this the level of?

Answer 4

L1 - The level of the ‘transpyloric plane’

Question 5

Where does the stomach receive parasympathetic innervation from?

Answer 5

Vagus nerve

Question 6

How does the left vagus come to lie anteriorly on the stomach and the right vagus posteriorly?

Answer 6

Rotation of stomach

Question 7

What is found:

1. Left
2. Right
3. Anteriorly
4. Posteriorly
5. Superiorly
6. Inferiorly

to the stomach?

Answer 7

1. Left - Spleen
2. Right - Liver
3. Anterior - Parietal peritoneum
4. Posteriorly - Pancreas
5. Superiorly - Diaphragm, oesophagus, lesser omentum
6. Inferiorly - Greater omentum

Question 8

What is a hiatus hernia?

Answer 8

Stomach passing through diaphragm

Question 9

What does the coeliac trunk supply?

Answer 9

Supplies the foregut and its two derivatives (liver, pancreas) and the spleen

Question 10

What does the SMA supply?

Answer 10

Passes within the mesentery to supply the midgut

Question 11

What does the IMA supply?

Answer 11

Runs into the transverse mesocolon to supply the hindgut

Question 12

What vertebral level does the coeliac trunk emerge?

Answer 12

T12

Question 13

What is the coeliac plexus?

Answer 13

Lies on each side of the coeliac trunk, forms the “hub” of the autonomic nerve supply to the abdominal viscera.

Question 14

What are the components of the midgut?

Answer 14

Half way along the second part of duodenum (major duodenal papilla)
Jejunum
Ileum
Caecum
Appendix
Ascending colon
Two thirds of transverse colon

Question 15

What is Meckel’s diverticulum? What % of the population is it present in?

Answer 15

2%

Bulge in the small intestine, can be present at birth and is vestigial remnant of the vitelline duct

Question 16

How is the large intestine distinguishable?

Answer 16

• 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.

Question 17

What is diverticulosis?

Answer 17

Pouching of the colon, usually in the region of the sigmoid colon

Question 18

What is diverticulitis?

Answer 18

Inflammation on a diverticuli due to some infection probably due to trapped faeces.

Question 19

What can the posterior wall of the caecum look like?

Answer 19

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.

Question 20

What merges at the root of the appendix?

Answer 20

3 taeniae coli

Question 21

Where does the appendicular artery arise?

Answer 21

Iliocolic artery

Question 22

What are symptoms of appendicitis?

Answer 22

Para-umbilical discomfort, accompanied by malaise, and diarrhoea or constipation, temperature

Within 24-48 hours, the pain localises to the right iliac fossa

Question 23

Why is it dangerous to use laxatives during appendicitis?

Answer 23

Vigorous contraction of the gut wall often ruptures the inflamed appendix, precipitating peritonitis

Question 24

Where is the site of maximum tenderness during appendicitis?

Answer 24

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.

Question 25

What are the different variations of where the appendix is?

Answer 25

In 65% of adults the appendix is retro-caecal; in 25% it hangs over the pelvic brim.

Question 26

Where can pus from appendix abscess travel? What pain follows?

Answer 26

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.

Question 27

Why is the colon most easily freed from its lateral side?

Answer 27

Blood vessels approach the colon medially from the midline, lateral resection avoid damaging these blood vessels.

Question 28

Describe the route of the colon

Answer 28

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

Question 29

At what level does the SMA arise?

Answer 29

L1

Question 30

Where does the SMA descend over?

Answer 30

The 3rd part of the duodenum

Question 31

What is the first branch of the SMA?

Answer 31

Inferior pancreatico-duodenal artery

Question 32

Where does the inferior pancreatico-duodenal artery come from?

Answer 32

Gastroduodenal artery