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Anatomy > Small Intestine and Large Intestine > Flashcards

Small Intestine and Large Intestine Flashcards

1
Q

What regulates and coordinates numerous GI tract activities?

A

enteric nervous system

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2
Q

What are the activities that the enteric nervous system regulates and controls?

A
  • gastric secretory activity
  • GI blood flow
  • peristalsis
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3
Q

Where is the ENS located?

A

between the walls of the GI tract

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4
Q

What is generally independent of CNS and receives input from sympathetic and parasympathetic innervation?

A

ENS

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5
Q

What is the sympathetic abdominal innervation and associated levels?

A
  • greater splanchnic (T5-T9)
  • lesser splanchnic (T10-T11)
  • least splanchnic (T12)
  • lumbar splanchnic (L1-L2/L3)
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6
Q

The greater splanchnic nerves run to the (1) ganglion which distribute to the (2)

A
  1. celiac
  2. foregut
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7
Q

The lesser and least splanchnic nerves run to the (1) and (2) which distribute to the (3)

A
  1. superior mesenteric ganglion
  2. aorticorenal ganglia
  3. midgut
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8
Q

The lumbar thoracic splanchnic nerves run to the (1) which distribute to the (2)

A
  1. inferior mesenteric ganglion
  2. hindgut
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9
Q

The celiac, superior mesenteric, aorticorenal, and inferior mesenteric plexus communicate via what?

A

intermesenteric plexus

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10
Q

What is the parasympathetic abdominal innervation and associated postganglionic distribution?

A
  • vagus n. (CN X) - foregut and midgut
  • pelvic splanchnic (S2-S4) - hindgut
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11
Q

Descending sympathetic innervation to the pelvic organs is via what plexuses?

A

superior hypogastric plexuses

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12
Q

What receives pelvic splanchnic nn. (parasympathetics)?

A

hypogastric nn (inferior hypogastric plexus)

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13
Q

What are the sympathetic activities of the abdominal organs and what do they go to?

A
  • vasoconstriction
  • decreased peristalsis
  • decreased hormonal secretion
  • goes to smooth muscle and glands
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14
Q

What are the parasympathetic activities of the abdominal organs and what do they go to?

A
  • vasodilation
  • increased peristalsis
  • increased hormonal secretion
  • goes to smooth muscle and glands
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15
Q

Pre-synaptic sympathetic fibers synapse directly into what?

A

suprarenal gland

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16
Q

What travels with sympathetic fibers (GSA)

A

pain (GVA)

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17
Q

What is the function of the small intestine?

A

absorption of nutrients

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18
Q

What are the parts of the small intestine?

A
  • duodenum
  • jejunum
  • ileum
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19
Q

What does the small intestine extend from?

A

from pylorus to ileocecal junction

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20
Q

What do the jejunum and ileum contain that increase surface area for absorption?

A

elaborate folds of mucosa

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21
Q

What part of the small intestine doesn’t absorb any nutrients?

A

duodenum

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22
Q

What vertebral levels does the duodenum travel from?

A

L1 to L3

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23
Q

How many parts of the duodenum are there and what are their associated vertebral levels?

A
  • 1st: superior part (L1)
  • 2nd: descending part (L2-L3)
  • 3rd: horizontal part (L3)
  • 4th: ascending part (L3)
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24
Q

What is the most movable part of the duodenum?

A

superior part (first)

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25
Q

What is the very first part of the duodenum called?

A

duodenal cap (ampulla)

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26
Q

What attaches the superior part (1st part) of the duodenum to the porta hepatis of the liver and what is contained in it?

A

hepatoduodenal ligament:
- portal triad
**common bile duct
**hepatic artery
**portal vein

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27
Q

What parts of the duodenum are retroperitoneal?

A

the 2nd and 3rd part

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28
Q

What part of the duodenum attaches to the pancreas?

A

2nd part

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29
Q

What is located in the 2nd part of the duodenum and is where the bile duct + main pancreatic duct connect to the duodenum and drain into?

A

hepatopancreatic ampulla

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30
Q

What is the landmark located halfway along the second part of the duodenum that marks the transition from foregut to midgut?

A

hepatopancreatic ampulla (ampulla of Vater)

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31
Q

The hepatopancreatic ampulla connects to the duodenum via what?

A

major duodenal papilla

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32
Q

What is the opening of the accessory pancreatic duct into the 2nd part of the duodenum?

A

minor duodenal papilla

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33
Q

What part of the duodenum is important for the hepatobiliary tract?

A

2nd part of the duodenum

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34
Q

What does the 3rd part of the duodenum run in front of?

A

IVC and aorta

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35
Q

What runs in front of the 3rd part of the duodenum?

A

superior mesenteric vessels

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36
Q

What is the duodenojejunal junction?

A

where the 4th part of the duodenum meets and continues as the jejunum

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37
Q

What is a thin band of tissue that connects the duodenojejunal junction to the right crus of the diaphragm?

A

ligament of Treitz

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38
Q

What is the ligament of Treitz critical in ruling out?

A

malrotation of the gut in children

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39
Q

A GI bleed above the ligament of Treitz will lead to (1)

A

vomiting up blood

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40
Q

A GI bleed below the ligament of Treitz will lead to (1)

A

dark, tarry, maybe purplish stool

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41
Q

What two arteries supplies the duodenum and what does this mark the transition of?

A
  • celiac trunk via gastroduodenal a
  • superior mesenteric artery via inferior pancreaticoduodenal a
    marks transition between foregut and midgut
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42
Q

What branches off the gastroduodenal artery to supply the upper portion of duodenum and head of pancreas?

A

ant. and post. superior pancreaticoduodenal a

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43
Q

What branches off the superior mesenteric artery and supplies the lower portion of the duodenum?

A

ant. and post. inferior pancreaticoduodenal a

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44
Q

What is the direct venous drainage of the duodenum?

A

hepatic vein

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45
Q

What is the indirect venous drainage of the duodenum?

A
  • superior mesenteric vein
  • splenic vein
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46
Q

The anterior lymphatic vessels of the duodenum drain into the (1) located alone the superior and inferior pancreaticoduodenal arteries and into the (2) which lie along the gastroduodenal artery, and then drains into (3)

A
  1. pancreaticoduodenal lymph nodes
  2. pyloric lymph nodes
  3. celiac lymph nodes
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47
Q

The posterior lymphatic vessels of the duodenum pass posterior to the head of the pancreas and drain into the (1); efferent lymphatic vessels from the duodenal lymph nodes drain into the (2)

A
  1. superior mesenteric lymph nodes
  2. celiac lymph nodes
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48
Q

What is the parasympathetic innervation of the duodenum?

A

vagus n

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49
Q

What is the sympathetic innervation pathway of the duodenum?

A
  • spinal cord T5-T11
  • greater and lesser splanchnic
  • celiac and superior mesenteric plexuses
  • peri-arterial plexuses extending to pancreaticoduodenal aa
  • duodenum
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50
Q

What does the jejunum begin at and what part of the small intestine is considered the jejunum?

A
  • begins at duodenojejunal flexure
  • proximal 2/5 of intestine
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51
Q

Where does the ileum end at and what part of the small intestine is considered the ileum?

A
  • ends at ileocecal junction
  • distal 3/5 of intestine
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52
Q

What keeps the jejunum and ileum attached to the posterior abdominal wall?

A

mesentery

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53
Q

What is the function of the jejunum?

A

lipid and protein digestion

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54
Q

What are in the jejunum but not in the ileum?

A

plicae circulares

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55
Q

How does the jejunum differ from the ileum?

A
  • thicker walls
  • larger diameter
  • arteries
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56
Q

What is the function of the ileum?

A

absorption of most digested nutrients

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57
Q

What has peyer’s patches?

A

ileum

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58
Q

How does the ileum differ from the jejunum?

A
  • thinner walls
  • smaller diameter
  • arteries
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59
Q

What is the caliber of the jejunum in relation to the ileum?

A

jejunum : greater
ileum : lesser

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60
Q

What is the plicae of the jejunum in relation to the ileum?

A

jejunum : many
ileum : few

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61
Q

What is the mesentery length of the jejunum in relation to the ileum?

A

jejunum : shorter
ileum : longer

62
Q

What is the peyer’s patches of the jejunum in relation to the ileum?

A

jejunum : few
ileum : present

63
Q

What is the vascularity of the jejunum in relation to the ileum?

A

jejunum : greater
ileum : less

64
Q

What is the length of vasa recta in the jejunum in relation to the ileum?

A

jejunum : longer
ileum : shorter

65
Q

How many arcades are there in the jejunum in relation to the ileum?

A

jejunum : few
ileum : many

66
Q

what extends from the duodenojejunal flexure obliquely downwards and to the right to the ileocecal junction?

A

root of the mesentery

67
Q

What is the arterial supply of the jejunum and ileum?

A

superior mesenteric artery
- jejunal aa
- ileal aa

68
Q

What are the characteristics of the jejunal aa?

A
  • less arcades
  • longer vasa recta
69
Q

What are the characteristics of the ileal aa?

A
  • more arcades
  • shorter vasa recta
70
Q

The jejunal and ileal aa unite to form loops or arches, called (1), which give rise to straight arteries, called (2)

A
  1. arterial arcades
  2. vasa recta
71
Q

Why are arterial arcades important?

A

may help maintain arterial perfusion of the gut if the mesentery is twisted or stretched

72
Q

What are the 6 branches of the SMA and mnemonic?

A

“In my room, I’m in jail”
I: inferior pancreaticoduodenal
M: middle colic
R: right colic
I: ileocolic
I: ileal
J: jejunal

73
Q

What does the inferior pancreaticoduodenal aa supply?

74
Q

What does the middle colic a supply?

A

transverse colon

75
Q

What does the right colic a supply?

A

ascending colon

76
Q

What does the ileocolic a supply?

A
  • ascending colon
  • small portion of ileum
  • cecum
77
Q

What do the ileum aa supply?

78
Q

What do the jejunal aa supply?

79
Q

What is the position of the SMV in relation to the SMA?

A

lies anterior and to the right of the SMA

80
Q

Where does the SMV end?

A

posterior to the neck of the pancreas

81
Q

What unites to form the hepatic portal vein?

A

SMV & splenic vein

82
Q

Where are lacteals found?

A

in intestinal villi (only in the jejunum and ileum)

83
Q

What is the function of lacteals?

A

absorb fat and drain into lymphatic plexuses in walls

84
Q

What do lacteals drain into?

A

cisterna chyli

85
Q

What are the 3 groups of lymph nodes in the lymphatic drainage of the jejunum and ileum and what do they drain into?

A
  • juxta-intestinal
  • mesenteric
  • central superior
    drain into superior mesenteric nodes
86
Q

Where are juxta-intestinal lymph nodes located?

A

close to the intestinal wall

87
Q

Where are mesenteric lymph nodes located?

A

scattered in arterial arches

88
Q

Where are central superior lymph nodes located?

A

along proximal SMA

89
Q

What do lymph nodes of the terminal ileum drain into?

A

ileocolic lymph nodes

90
Q

What is the pattern of sympathetic innervation of the jejunum and ileum?

A
  • spinal cord T8-T10
  • greater, lesser, least splanchnic nn
  • superior mesenteric nerve plexus
  • synapse on celiac and superior mesenteric ganglia
  • pre-arterial nerve plexuses on SMA branches
91
Q

What provides parasympathetic innervation to the jejunum and ileum (specific trunk)?

A
  • vagus nerve (posterior vagal trunks)
    preganglionic synapse with postganglionic in myenteric and submucosal plexuses in intestinal wall
92
Q

What type of fibers does the parasympathetic innervation provide to the jejunum and ileum?

A

intestine sensory fibers (GVA)

93
Q

Intestine sensory fibers (GVA) are (1) to most pain stimuli, including cutting and burning; but are (2) to sudden distention (gas) and transient ischemia from abnormally long contractions (colic, spasmodic abdominal pains)?

A
  1. insensitive
  2. sensitive
94
Q

What is the function of the large intestine?

A

water absorption and create feces
- helps reabsorb electrolytes and makes vitamins

95
Q

Without enough electrolytes, what can happen?

A

small bowel obstruction

96
Q

What does the large intestine span from?

A

ileocecal fold to the anus

97
Q

What are the large intestine characteristics?

A
  • omental appendices
  • teniae coli
  • haustra
  • great internal diameter
98
Q

What are small, fatty, omentum-like projects in the large intestine?

A

omental appendices

99
Q

What is a thickened band of smooth muscle in the large intestine that is absent in the rectum and appendix?

A

teniae coli

100
Q

What are the sacculations of the wall of the colon between the teniae?

101
Q

What are the retroperitoneal organs and mnemonic?

A

SAD PUCKER
S: suprarenal gland
A: aorta/IVC
D: duodenum (2nd and 3rd)
P: pancreas (except tail)
U: ureters
C: colon (ascending/descending)
K: kidneys
E: esophagis
R: rectum

102
Q

What parts of the large intestine are retroperitoneal structures?

A
  • ascending colon
  • descending colon
  • rectum
103
Q

Most tumors of the large intestine occur in the (1) and (2) or (3)

A
  1. sigmoid colon
  2. rectum
  3. ascending colon
104
Q

Tumors in the ascending colon are more common among (1) and (2)

A
  • women
  • older patients
105
Q

Rectosigmoidal tumors are more common among (1) and (2)

A
  1. men
  2. younger patients
106
Q

With suspected GI bleeds, where is a person scoped first and why?

A

from above because an upper GI bleed is more life threatening

107
Q

The interior of the colon can be observed and photographed in a procedure called (1) or (2)

A
  1. colonoscopy
  2. coloscopy
108
Q

The interior of the sigmoid colon is observed with a (1), a shorter endoscope, in a procedure called (2)

A
  1. sigmoidoscope
  2. sigmoidoscopy
109
Q

What is a blind-ended pouch in the RLQ that has no mesentery so it may be displaced?

110
Q

What is suspended from the cecum and contains masses of lymphoid tissues?

111
Q

What is the portion of mesentery connecting the ileum to the appendix?

A

meso-appendix

112
Q

What can contain blind diverticulum?

113
Q

What is found 2/3 of the way from umbilicus to ASIS?

A

McBurney’s point

114
Q

Acute inflammation of the appendix, (1), is a common cause of an acute abdomen

A
  1. appendicitis
115
Q

Digital pressure over the (1) registers maximum abdominal tenderness in appendicitis?

A

McBurney point

116
Q

What is appendicitis in young people usually caused by?

A

hyperplasia of lymphatic follicles in appendix that occludes the lumen

117
Q

What is appendicitis in older people usually caused by?

A

an obstruction from fecalith, a cocreation formed around fecal matter

118
Q

The pain of appendicitis usually commences as vague pain in the (1) because of afferent pain fibers entering the spinal cord at T10 level; later the sever pain transmits to (2) from irritation of parietal peritoneum lining the posterior abdominal wall

A
  1. umbilical region
  2. right lower quadrant
119
Q

Acute infection of the appendix may result in (1) in the (2) artery

A
  1. thrombosis
  2. appendicular
120
Q

The ascending colon is covered anteriorly and on both sides with (1)

A
  1. peritoneum
121
Q

What is located between the lateral aspect of the ascending colon and adjacent abdominal wall AND extends between right subphrenic space to the pelvis?

A

right paracolic gutter

122
Q

What is the right colic flexure?

A

where the ascending colon turns into transverse colon

123
Q

Why are the paracolic gutters clinically important?

A

allow for passage for infectious fluids from different compartments of abdomen
- ex: fluid from infected appendix can track up to the right paracolic gutter to hepatorenal recess

124
Q

What is found between right and left colic flexures, and is horizontally oriented?

A

transverse colon

125
Q

What is the transverse colon suspended from the posterior abdominal wall by?

A

transverse mesocolon

126
Q

What is the most mobile part of the large intestine?

A

transverse colon

127
Q

What is found between the left colic flexure to the left side of the groin?

A

descending colon

128
Q

What covers the colon anteriorly and laterally, binding it to the posterior abdominal wall?

A

peritoneum

129
Q

What is found between the lateral aspect of the descending colon and adjacent abdominal wall?

A

left paracolic gutter

130
Q

What is “S” shaped, and begins at the pelvic inlet and descends to the level of S3?

A

sigmoid colon

131
Q

What is the sigmoid attached to the pelvic wall by?

A

sigmoid mesocolon (mesentery)

132
Q

What does the sigmoid colon have and why it is important?

A
  • considerable freedom of movement
  • important because this part of colon can get firm/hard as bowel moves through so you need the sigmoid colon to be able to move around
133
Q

What is the most common site for diverticulitis?

A

sigmoid colon

134
Q

What is a fixed, retroperitoneal organ that is continuous with the sigmoid colon at S3?

135
Q

What is the rectum continuous with inferiorly?

A

anal canal

136
Q

What branches off the aorta at L3?

A

inferior mesenteric artery

137
Q

What are the 3 branches of IMA?

A
  • left colic a
  • sigmoid aa
  • superior rectal artery
138
Q

What is the main artery that gives off the marginal artery?

A

left colic artery

139
Q

What gives off an appendicular artery that is important for the appendix?

A

ileocolic artery

140
Q

What does the left colic artery supply?

A

descending colon

141
Q

What do the sigmoidal arteries supply?

A

sigmoid colon

142
Q

What does the superior rectal artery supply?

143
Q

What provides collateral circulation to the large intestine?

A

marginal artery

144
Q

What is the venous drainage of the large intestine?

A

portal system of veins
- superior mesenteric vein
- splenic vein
- inferior mesenteric vein
portal vein
- splenic v + SMV; R and L branches

145
Q

What joins the splenic vein and drains blood from the hindgut?

A

inferior mesenteric vein

146
Q

What is the lymphatic drainage of the cecum and appendix?

A

lymph nodes in meso-appendix drain to ileocolic nodes

147
Q

What is the lymphatic drainage of the ascending colon?

A
  • epicolic and paracolic nodes drain to:
  • ileocolic and intermediate right colic nodes which drain to:
  • superior mesenteric nodes
148
Q

What is the lymphatic drainage of the transverse colon?

A
  • middle colic nodes drain to
  • superior mesenteric nodes
149
Q

What is the lymphatic drainage of the descending and sigmoid colons?

A
  • epicolic and paracolic drain to intermediate colic nodes which drain to inferior mesenteric nodes
  • left colic flexure nodes drain to superior mesenteric nodes
150
Q

What is the sympathetic innervation of the large intestine?

A
  • superior mesenteric plexus
    **cecum and appendix
    **ascending colon
    **transverse colon
  • lumbar part, inferior mesenteric plexus, and peri-arterial plexuses following IMA:
    **descending and sigmoid colon
151
Q

What is the parasympathetic innervation of the large intestine proximal to the left colic flexure?

A

vagus nerve

152
Q

What is the parasympathetic innervation of the large intestine distal to the left colic flexure?

A

pelvic splanchnic nerves (S2-S4)
- via inferior hypogastric plexus and nn

Anatomy (25 decks)

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