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Gross anatomy > Stomach, midgut and associated arteries. > Flashcards

Stomach, midgut and associated arteries. Flashcards

1
Q

What are the relations of the stomach?

A

Anterior - Diaphragm, left lobe of liver

Posterior - Omental bursa, pancreas

Superior - Diaphragm, left lobe of liver, lesser omentum (from lesser curvature)

Inferior - Transverse colon to the left colic flexure (also laterally)

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2
Q

What is the ‘bed of the stomach’?

A

The surface upon which the stomach lies when in a supine position. Formed by (superior ->inferior): left dome of the diaphragm, spleen, left kidney, suprarenal gland, splenic artery, pancreas, and transverse mesocolon.

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3
Q

Describe the the sections of the stomach.

A

Cardia (immediately inferolateral to the oesophagus) Fundus (most superior) Body (largest part) Pyloric antrum (immediately lateral to the pyloric canal) Pyloric canal (contains the pylorus, lateral to the proximal end of the duodenum

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4
Q

Is the cardiac orifice and anatomical sphincter?

A

No - physiological: functional sections of the oesophagus that act as a sphincter but are not thickened.

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5
Q

Is the pylorus an anatomical sphincter?

A

Yes - comprises a thickened ring of muscle.

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6
Q

At what vertebral level does the pylorus normally lie?

A

Lower border of LI - transpyloric plane.

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7
Q

Describe the position of the left vagus in relation to the stomach.

A

The left vagus twists with the oesophagus and at the level of the oesophageal sphincter the L vagus courses across the anterior wall of the stomach.

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8
Q

Describe the position of the right vagus in relation to the stomach.

A

The right vagus twists with the oesophagus and at the level of the oesophageal sphincter the R vagus courses across the posterior wall of the stomach.

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9
Q

What is a hiatus hernia?

A

Protrusion of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.

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10
Q

How does a hiatus hernia differ from a congenital diaphragmatic hernia?

A

The latter is caused by a congential defect in the diaphragm. Allows the abdominal contents to push into the thorax in utero and causes lung underdevelopment.

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11
Q

Name the three main branches of the aorta that supply the GI tract.

A

Coeliac trunk (foregut + liver and pancreas) Superior mesenteric (midgut) Inferior mesenteric (hindgut)

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12
Q

The common hepatic forms three branches. What are they?

A

Hepatic artery proper (single ascending branch to R) Supraduodenal and gastroduodenal (initially single descending branch to R that bifurcates, former to R, latter to L).

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13
Q

What is the origin of the R gastric?

A

Hepatic artery proper - descends to the L and anastamoses with L gastric.

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14
Q

What is the origin of the cystic artery?

A

R branch of hepatic artery proper.

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15
Q

Describe the further divisions of the gastroduodenal artery.

A

R gastro-omental (most superior, anastamoses with L gastro-omental) Superior pancreatoduodenal

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16
Q

What is the origin of the posterior gastric artery?

A

Middle of the splenic, ascending branch.

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17
Q

What is the origin of the of the left gastro-omental artery?

A

Distal portion of the splenic, descending branch.

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18
Q

Describe the origins of the short gastric arteries.

A

Distal portion of the splenic, ascending branches.

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19
Q

At what vertebral level is the coeliac trunk given off?

A

Lower T12/upper L1

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20
Q

From where does the stomach receive parasympathetic innervation?

A

The oesophageal plexus, formed mainly from the vagus nerves, but also with contribution from the pelvic splachnic nerves (to distal colon).

21
Q

What are the splanchnic nerves?

A

The splanchnic nerves are paired visceral nerves (nerves that contribute to the innervation of the internal organs), carrying fibers of the autonomic nervous system (visceral efferent fibers) as well as sensory fibers from the organs (visceral afferent fibers). All carry sympathetic fibers except for the pelvic splanchnic nerves, which carry parasympathetic fibers.

22
Q

From where does the abdominal cavity receive sympathetic innervation?

A

The sympathetic system in the abdomen comprises two ganglionated trunks and a network of nerves (the aortic or prevertebral plexuses) covering the surface of the aorta.

23
Q

Where do the sympathetic trunks enter the abdomen?

A

Behind the medial arcuate ligament of the diaphragm, descending along the medial border of psoas major, the trunk on the right lying posterior to the inferior vena cava. Each trunk passes behind the common iliac vessels and crosses the pelvic inlet at the ala of the sacrum.

24
Q

List the compentents of the midgut.

A

Duodenum (distal 1/2 of 2nd part, 3rd and 4th part) Jejunum Ileum Caecum Appendix Ascending colon Hepatic flexure Transverse colon (proximal 2/3)

25
Q

Describe the venous drainage from the midgut.

A

The hepatic portal system.

26
Q

Describe the lymphatic drainage from the midgut.

A

Prevertebral superior mesenteric nodes

27
Q

Describe the autonomic innervation of the midgut.

A

Superior mesenteric plexus

28
Q

What are the relations of the duodenum?

A

Anterior - liver and gall bladder.

Superior (descending duodenum) are the transverse colon and mesocolon, (inferior duodenum) superior mesenteric vessels.

Posterior - (superior duodenum) portal vein, the bile duct and the gastroduodenal artery, (descending duodenum) hilum of the right kidney and the right renal vessels, (inferior duodenum) right ureter and gonadal vessels, the inferior vena cava, aorta and origin of the inferior mesenteric artery, (ascending duodenum) left psoas muscle, the left gonadal and renal vessels and the inferior mesenteric vein.

29
Q

Where does the jejunum commence?

A

The duodenojejunal flexure.

30
Q

What are the characteristic features of the jejunum (when compared with the ileum)?

A

Deeper red 2-4cm caliber (ileum 2-3)

Wall thick and heavy

Greater vascularity Long vasa recta

Arcades: few large loops (ileum: many short loops)

Less fat in mesentery

Plicae circulares (circular folds): large, tall and closely packed (low and sparse in proximal ileum, absent in distal ileum)

Few lymphoid nodules (Ileum has Peyer’s patches)

31
Q

What is Meckel’s diverticulum and what is its prevelance?

A

Vestigial remnant of the vitteline duct - true congenital diverticula are present in the distal ileum, usually within 2 feet of the iliocaecal valve.

32
Q

What are the distuguising features of the large bowel?

A

Greater calibre

Three taenia coli - longitudinal muscle layers

The presence of sacculations known as haustra

Fat-filled tags - appendices epiploicae

33
Q

What is diverticulosis?

A

The condition of having diverticula present in the large bowel.

34
Q

What is diverticulitis?

A

Inflammation of one of more large bowel diverticula.

35
Q

Describe the caecum.

A

A blind pouch of large bowel that projects downwards from the beginning of the asceding colon, below the ileocaecal junction.

36
Q

At which point do the three taenia coli merge?

A

The vermiform appendix.

37
Q

Define the mesoappendix. What is the name of the artery that runs through it?

A

The mesentery of the appendix. The appendicular artery.

38
Q

What is the origin of the appendicular artery?

A

Iliocolic

39
Q

Describe the symptoms of appendicitis.

A

Pain usually begins as para-umbilical discomfort, accompanied by malaise, diarrhoea/constipation and pyrexia. Within 24-48 hours the pain usually refers to the right iliac fossa.

40
Q

What name is given to the surface marking point of the appendix?

A

McBurney’s point - site of maximum tenderness in appendicitis. Lies at a junction joining the lateral one-third with the medial two-thirds of a line between the ASIS and the umbilicus.

41
Q

How can pus from the appendix reach the subphrenic space? To where would pain refer in this case?

A

By tracking up the right paracolic gutter. Pain refers to the right shoulder.

42
Q

In what percentage of people does the appendix hang over the pelvic brim?

A

25%

43
Q

In what percentage of people is the appendix retrocaecal?

A

65%

44
Q

At what vertebral level is the superior mesenteric artery given off?

A

Lower border of L1

45
Q

What is the first branch of the sup. mesenteric artery?

A

Inferior pancreatico-duodenal

46
Q

Starting with the most superior, what are the right branches of the sup. mesenteric artery and what do they supply?

A

Middle colic - transverse colon

R colic - Ascending colon

Iliocolic - terminal branch, supplies ilium, caecum and ascending colon.

47
Q

Starting with the most superior, what are the left branches of the sup. mesenteric artery and what do they supply?

A

Jejunal - jejunum

Ileal - ileum

48
Q

What is the name given to the arterial tributeries most proximal to the gut in the jejunum and ileum?

A

Vasa recta

49
Q

Name the structures supplied by the superior mesenteric artery.

A

Pancreas

Distal portion of duodenum

Jejunum

Ileum

Caecum

Vermiform appendix

Ascending colon

Hepatic flexure

Proximal 2/3 of tranverse colon

Gross anatomy (9 decks)

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