The Gut, Blood Supply and ANS

Question 1

What are the branches of the coeliac trunk?

Answer 1

(T12) Splenic artery, Common hepatic artery and left gastric artery

Question 2

What is the position of the stomach?

Answer 2

left epigastric region
fundus at ribs 5/6
oesophagus at costal cartilages 7/8
pylorus at L1 (trans pyloric plane)

Question 3

What is the arterial supply to the stomach? (Lesser curvature, greater curvature, fundus)

Answer 3

Lesser curvature- left gastric (Coeliac trunk) right gastric (common hepatic)
Greater curvature- left gastro-omental (splenic) and right gastro-omental (gastroduodenal, common hepatic)
Fundus- short gastric (splenic)

Question 4

Where is the duodenum and what is its structure?

Answer 4

Spans L1 to L3.
Superior part (intra peritoneal)
Descending part
Inferior part
Ascending part

Question 5

What is the duodenums arterial supply?

Answer 5

SUP half: superior pancreatoduodenal arteries ( from gastroduodenal, Coeliac origin)
INF half: inferior pancreatoduodenal arteries ( SMA origin)

NB makes sense as foregut/ midgut transition)

Question 6

What is the duodenums nervous supply, venous drainage and lympahtics?

Answer 6

Nerve- Coeliac plexus and Sup. Mesenteric plexus
Venous- Sup. half to portal vein, inf half to SMV
Lymphatics- Sup half to coeliac nodes, inf half to sup. mesenteric nodes. (ALL PRE AORTIC)

Question 7

What is the Ampulla of Vater, and the major duodenal papilla?

Answer 7

Ampulla of Vater- Where common bile duct and main pancreatic duct meet.
Major duodenal papilla- nipple like process in DESCENDING duodenum. (sphincter of oddi)

Question 8

What is the arcading pattern of the jejunum and ileum?

Answer 8

Jejunum has few arcades and longer vasa recta

Ileum has more arcades and shorter vasa recta

Question 9

What is the arterial supply of the small intestine?

Answer 9

Jejunal and Ileal arteries that are branches of the SMA

Question 10

What is the arterial supply of the large intestine that come from the SMA? (midgut)

Answer 10

Caecum/appendix: Caecal and appendicular arteries from ileocolic art.
AScending colon: Right colic artery
Proximal 2/3 of transvere colon: Middle colic and marginal artery

Question 11

What is the arterial supply of the large intestine that come from the IMA? (hindgut)?

Answer 11

Distal 1/3 transverse colon: Marginal artery and left colic
Descending colon: left colic artery
Sigmoid colon: sigmoid artery

Question 12

What spinal level is the rectum located at is it covered in peritoneum?

Answer 12

S3
Rectum is retro peritoneal with first third covered in visceral peritoneum, mid third has peritoneum on the ant surface and the lower third is INFRAperitoneal.

Question 13

What is the rectums blood supply?

Answer 13

Sup. third: superior rectal branches from IMA (L3)
Mid third: Midlle rectal branches from internal iliac
Inf third: Inferior rectal branches from internal pudendal

Question 14

What is the venous drainage of the rectum?

Answer 14

Sup third: opposite, but to portal
mid third and inf third go opposite but end up in the IVC

portal systemic anastamosis

Question 15

What is the lymphatics and ANS supply of rectum?

Answer 15

Sup third: IM nodes and IM plexus

Distal 2/3: Inguinal nodes and hypogastric plexus

Question 16

What ANS nerves supply the gut?

Answer 16

SNS: Thoracic, lumbar and sacral SPLACHNIC nerves from T5 to L2

PSNS: Vagus nerve and pelvic splachnic nerves S2-S4

Question 17

Ho does the ANS nerve supply vary among foregut midgut and hindgut?

Answer 17

Foregut: Celiac plexus, with greater splachnic nerves T5-T9 and vagus nerve
Midgut: SM plexus with lesser splachnic nerves at T10 and T11 and vagus nerve
Hindgut: IM and sup. hypogastric plexi, lumbar and sacral splachnic L1,L2, S1, S2, and PSNS is the pelvic splachnic S2-S4

Question 18

Describe referred pain and the splachnic nerves associated

Answer 18

Foregut, greater splachnic, T5-T9 so epigastric pain,
Midgut, lesser splachnic T10 and T11, umbilical region
Hindgut L1 and L2, suprapubic region