The gut Flashcards
What are the structures in place preventing reflux of stomach contents up oseophagus?
- Lower oesophageal sphincter
- Diaphragmatic crura
- Angle of His
- Phreno-oesophageal ligament
- Viscera (intra-abdominal pressure)
- Thick mucosa at gastro-oesophageal junction
What are the locations of reflections of the parietal peritoneum?
- Falciform and coronary ligaments of the liver
- Greater omentum
- Lesser omentum
- Gastrosplenic ligament
- Lineorenal ligament
- Small bowel mesentery
What are the regions of the peritoneal cavity?
- Greater sac
- Lesser sac
- Epiploic foraman (connection)
What are the sections of the peritoneal cavity divided by the transverse colon and asociated mesentery?
- Supracolic compartment
- Infracolic compartment
What are the different parts of the stomach?
- Cardia
- Fundus
- Body
- Antrum
- Pylorus
What are the different parts of the borders of the stomach?
- Greater curvature
- Angular incisura
- Lesser curvature
- Angle of His
What is the blood supply of the stomach?
- Left gastric artery
- Splenic artery:
- Short gastric artery
- Left gastroepiploic artery - Common hepatic artery:
- Right gastric artery
- Gastroduodenal artery (right gastroepiploic artery)
What is the parasympathetic supply to the stomach?
- Vagus nerve (anterior and posterior vagal trunk)
- Functions include:
1. Increase gastric motor activity
2. Increase secretion
3. Open pyloric sphincter
What is the sympathetic supply to the stomach?
- Greater splanchnic (via coeliac plexus)
- Functions include:
1. Reduces gastric blood supply
2. Reduces gastric motor activity
3. Reduces gastric secretion
What is the lymphatic drainage of the stomach?
Pre-aortic coeliac lymph nodes
What is the structure of the greater omentum?
- Consists of 4 layers of visceral peritoneum.
- Attached to the greater curvature of the stomach.
- Hangs over transverse colon, jejunum and ilium like apron.
What is the structure of the lesser omentum?
- Consists of 2 layers of visceral peritoneum
- Attached to the lesser curvature of the stomach
- Its free edge makes up anterior wall of epiploic foraman
What are the ligaments that make up the lesser sac?
- Gastrohepatic
- Gastroduodenal
What are the contents of the epiploic foraman?
- Hepatic portal vein (posterior)
- Common bile duct (right)
- Hepatic artery (left)
What are the contents of the gastrosplenic ligament?
- Short gastric artery
- Left gastroepiploic artery
What are the divisions of the duodenum?
- Superior (5 cm)
- Descending (8 cm)
- Inferior (10 cm)
- Ascending (2.5 cm)
What are the relations of the superior part of the duodenum?
- First half intraperitoneal, rest retroperitoneal.
- Anterior: Liver and gallbladder.
- Superior: Epiploic foraman.
- Inferior: Pancreas.
What are the relations of the descending part of the duodenum?
- Right of IVC and vertebral column.
- Common bile duct and main panreatic duct drains into this part via ampulla of Vater and major duodenal papilla (defining boundary between foregut and midgut) on posteromedial side.
- Accessory pancreatic duct drains into minor duodenal papilla superior to major.
- Medial: Pancreas.
- Lateral: Ascending colon.
What are the relations of the inferior part of the duodenum?
- Crosses IVC and aorta at level L3.
- Largest section of duodenum.
- Anterior: Small bowel mesentery, superior mesenteric vessels.
- Left: Left kidney and ureter.
- Superior: Body of pancreas.
What are the relations of the ascending part of the duodenum?
- Ends at T2 at the duodenojejunal flexure.
- Partly retroperitoneal and partly intraperitoneal.
- Anterior: Transverse colon/mesocolon.
- Left: Left kidney and ureter.
- Superior: Body of pancreas.
What are the relations of the root small bowel mesentery?
- Starts superiorly on left side at level L2 at duodenojejunal flexure.
- Ends in front of the sacroiliac joint.
- Root is ~15cm long.
What are the features of the jejunum?
- Upper 2/5
- Located in umbilical region
- Thick red walls and wider lumen
- Fewer vascular arcades
- Less fatty mesentery
- Tall villi and deep crypts
- Thich vascular mucosa
- Few lymphoid follicles
What are the features of the ilium?
- Lower 3/5
- Suprapulic region and pelvis
- Thinner pink walls and narrower lumen
- Numerous vascular arcades
- Lots of fat in mesentery
- Shorter villi and shallower crypts
- Thinner vascular mucosa
- Peyer’s patches
What is the blood supply of the small intestine?
- Duodenum:
- Superior pancreaticoduodenal artery (gastroduodenal artery)
- Inferior pancraticoduodenal artery (superior mesenteric artery) - Jejunum: Jejunal branches of SMA
- Ilium: Ilial branches of SMA
What is the innervation of the small intestine?
Sympathetic is from lesser splanchnic
What is the lymphatic drainage of the small intestine?
Mesenteric nodes, pre-aortic lymph nodes and then cisterna chyli
What are the features of the colon?
- Taeniae coli
- Sacculations
- Appendices epiploicae
What are the structural features of the colon?
- Transverse and sigmoidal colon are intraperitoneal, rest are retroperitoneal.
- The hepatic flexure is located between ascending and transverse colon.
- The splenic flexure is located between transverse and descending colon.
- The para-colic gutters are located laterally to the ascendign and descending parts.
What is the blood supply to the colon?
- Caecum and appendix: Ileocolic artery
- Ascending colon: Right colic artery
- Transverse colon: Middle colic artery
- Descending colon: Left colic artery
- All anastomose to form marginal artery
- Sigmoidal colon: Sigmoidal artery
What is the lymphatic drainage of the colon?
Mesenteric nodes, pre-aortic nodes and the cisterna chyli
