The Stomach And The Small And Large Intestine Flashcards
1
Q
At what level is the oesophageal hiatus in the diaphragm
A
T10
2
Q
Length of abdominal segment of oesophagus
A
Less than 2cm
3
Q
Muscle around the oesophageal hiatus
A
Functions as a sphincter that prevents reflux of the stomach contents into the oesophagus
4
Q
Arterial supply of distal oesophagus
A
Branches of the left gastric artery
5
Q
Venous drainage of the distal oesophagus
A
Towards both the systemic system of veins via oesophageal veins that drain into the azygos vein
And to the portal venous system via the left gastric veins
6
Q
Distal oesophagus to portal venous system
A
Via left gastric veins
7
Q
Shape of stomach
A
J-shaped that expands to accommodate food and fluid
8
Q
Distal oesophagus to azygos vein system
A
Via oesophageal veins
9
Q
What does the stomach break food down into
A
Chyme
10
Q
4 parts of the stomach
A
Cardia
Fundus
Body
Pylorus
11
Q
Cardia of the stomach
A
Continuous with the oesophagus
12
Q
Fundus of the stomach
A
Most superior part
Lies superior to the level of entry of the oesophagus
Usually filled with gas
13
Q
Body of the stomach
A
Largest part
14
Q
Pylorus of the stomach
A
Pyloric antrum is wide and tapers towards the pyloric canal, which is narrow and contains the pyloric sphincter
15
Q
Pyloric sphincter
A
Formed of circular smooth muscle
Regulates the passage of chyme into the duodenum
16
Q
Why border of the stomach has greater curvature
A
Longer left border
17
Q
Which quadrant does the stomach lie in
A
Left upper quadrant
18
Q
What is the anterior surface of the stomach related to
A
Anterior abdominal wall
Diaphragm
Left lobe of liver
19
Q
What does the posterior wall of the stomach form
A
Anterior wall of the lesser sac
20
Q
Lesser omentum
A
Connects the lesser curvature to the liver
21
Q
What does the free edge of the lesser omentum contain
A
Hepatic artery
Hepatic portal vein
Bile duct
22
Q
Greater omentum
A
Hangs from the greater curvature of the stomach
23
Q
Arterial supply to the stomach
A
Arteries that branch from the coeliac trunk
24
Q
What does the foregut comprise
A
Stomach, first 1/2 of duodenum, liver, gallbladder, pancreas
25
What does the coeliac trunk supply
Viscera that are derived from the embryonic foregut and the spleen
26
At what level of vertebrae does the coeliac trunk branch from the anterior aspect of the abdominal aorta
T12
27
Embryonic origins of the spleen
Develops in the dorsal mesentry
Mesodermal in origin
28
3 branches of the coeliac trunk
Left gastric artery
Common hepatic artery
Splenic artery
29
Left and right gastric arteries
Run along lesser curvature of the stomach and anastomose with each other
30
What does the left gastric artery arise from
Coeliac trunk
31
What does the right gastric artery arise from
Either the common hepatic artery or the hepatic artery proper
32
Left and right gastro-omental arteries
Run along the greater curvature of the stomach and anastomose with each other
33
What does the left gastro-omental artery arise from
Splenic artery
34
What does the right gastro-omental artery arise from
Gastroduodenal artery (a branch of the common hepatic artery)
35
What do the right and left gastric veins and the right and left gastro-omental veins drain into
Hepatic portal vein
36
Parasympathetic stimulation of the stomach
Vagus nerve
Promotes peristalsis and gastric secretion
37
Sympathetic innervation of the stomach
Greater splanchnic nerve (preganglionic sympathetic fibres that leave spinal cord segments T5-T9 and pass through sympathetic trunk without synapsing)
Postganglionic fibres travel to stomach
Inhibit peristalsis and secretion
38
Hiatus hernia
The abdominal oesophagus and upper part of the stomach may herniate through the oesophageal hiatus into the thorax. If contents of the stomach reflux into the oesophagus the patient may experience heartburn (a burning feeling in the chest after eating) and acid reflux (regurgitation of bitter fluid).
39
Gastric ulcer
Mucous lines the internal wall of the stomach and protects the mucosa from the acidic stomach contents. A gastric (stomach) ulcer develops when the mucosal lining of the stomach breaks down. This is normally due to infection with Helicobacter pylori, which erodes the mucosal lining, exposing the muscular wall to gastric acid and enzymes. Erosion through the wall and into nearby blood vessels can result in catastrophic intra-abdominal bleeding.
40
Pyloric stenosis
This is a congenital malformation characterised by hypertrophy of the circular smooth muscle of the pyloric sphincter. It is more common in baby boys than girls and typically presents at approximately six weeks after birth. The typical presentation is of vomiting (sometimes projectile) after feeds, but the baby does not appear unwell and is hungry and willing to take more feeds. With continued vomiting, babies with pyloric stenosis become dehydrated and stop gaining weight. It can be treated surgically.
41
Is pyloric stenosis more common in boys or girls
Boys
42
At what age does pyloric stenosis typically present
6 weeks after birth
43
Gastric cancer
Primary cancer of the stomach may present late as some of the symptoms are non- specific. Symptoms include abdominal discomfort, early satiety (feeling full quickly), loss of appetite, nausea, weight loss, difficulty swallowing and indigestion.
44
3 parts of the small intestine
Duodenum
Jejunum
Ileum
45
What is the duodenum continuous with
Pylorus of the stomach
46
Shape of duodenum
Short and curved into a C-shape around the head of the pancreas
47
Is the duodenum retroperitoneal or intraperitoneal
Most of the length is retroperitoneal
48
Major duodenal papilla
Opening of the bile duct and main pancreatic duct
1/2 along internal wall of duodenum
49
Embryological origins of first 1/2 of duodenum
Embryological foregut
50
Embryological origins of second 1/2 of duodenum
Embryological midgut
51
Arterial supply to the first 1/2 of duodenum
Arterial branches of the coeliac trunk
52
Arterial supply to the second 1/2 of duodenum
Superior mesenteric artery
53
Are the Jejunum and ileum retroperitoneal or intraperitoneal
Intraperitoneal
Suspended from the posterior abdominal wall by the mesentery of the small intestine
54
What are the Jejunum and ileum derived from
Embryological midgut
55
Mesentery
Posterior wall
56
How is the Jejunum and ileum adapted for nutrient absorption
Vast surface area:
Long
Plicae circulares = mucosa is folded
Villi and microvilli
57
Differences between Jejunum and ileum
Plicae are more pronounced in Jejunum
Internal ileum characterised by Peyer’s patches (large submucosal lymph nodules)
58
Peyer’s patches
Large submucosal lymph nodules in ileum
59
Plicae circulares
Folds of the small intestine mucosa
60
Meckel’s diverticulum
In some people
A blind-ended diverticulum approx 1m from the ileum’s termination
Embryological remnant of the connection between the midgut loop and yolk sac
61
Inflammation of the Meckel’s diverticulum
May mimic appendicitis
62
Ileocaecal junction
Terminal ileum is continuous with the caecum
In right iliac fossa
63
Role of large intestine
Reabsorbs water for faecal material to form semi-solid faeces
64
What is the large intestine composed of
caecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anal canal.
65
Taeniae coli
Outer longitudinal muscle layer of large intestine
Organised into 3 bands
function as suspension cables upon which the circular muscle arcs are suspended, facilitating efficient contraction of the circular muscle
66
Haustra
Bulges formed by the inner circular muscle layer of the large intestine
67
Epiploic appendages
Fatty tags that mark the point at which blood vessels penetrate the intestinal wall of the large intestine
68
Caecum
First part of the large intestine
Distended, blind-ended pouch
Covered by the peritoneum but does not have a mesentery
69
Appendix
A small diverticulum that arises from the caecum
Contains lymphoid tissue
Varies in length
70
McBurney’s point
Surface marking of the base of the appendix
71
Mesoappendix
Small mesentery which connects the appendix to the caecum
72
Ascending colon
Continuous with caecum
Runs vertically on right side of posterior abdominal wall on right paracolic gutter
73
Is the ascending colon retroperitoneal or intraperitoneal
It is a secondarily retroperitoneal organ
74
Hepatic flexure (right colic flexure)
ascending colon makes a 90 degree turn left in the right upper quadrant, becoming continuous with the transverse colon
75
Transverse colon
Continuous with ascending colon
Runs horizontally in the abdomen but often hangs inferiorly
76
Transverse mesocolon
Suspends the transverse colon from the posterior abdominal wall
77
Is the transverse colon retroperitoneal or intraperitoneal
Intraperitoneal
78
Splenic flexure (left colic flexure)
transverse colon makes a 90 degree turn inferiorly in the left upper quadrant, becoming continuous with the descending colon.
79
Phrenicocolic ligament
Tethers to splenic flexure to the diaphragm
80
Embryological development of the transverse colon
proximal (first) two thirds develop from the embryological midgut, whilst the distal (last) third develops from the embryological hindgut
81
Descending colon
Continuous with the transverse colon
Runs vertically on the left side of the posterior abdominal wall in the left paracolic gutter
82
Is the descending colon retroperitoneal or intraperitoneal
Secondarily retroperitoneal organ
83
Sigmoid colon
Lies in left lower quadrant
Continuous with descending colon and rectum
84
Rectosigmoid junction
As the sigmoid approaches the midline, it makes a 90 degree turn inferiorly into the pelvis
85
Sigmoid mesentery
Sigmoid colon has a mesentery
It is intraperitoneal
86
Rectum
Lies in the pelvis
Continuous with rectosigmoid junction and anal canal
Stores faeces
87
Is the rectum retroperitoneal or intraperitoneal
Retroperitoneal
88
At what level of the rectosigmoid junction
S3
89
Superior mesenteric artery leaves aorta at level of
L1
90
Superior mesenteric artery supplies
Midgut
1/2 half of duodenum, small intestine, large intestine as far as first 2/3 of transverse colon
Branches also supply parts of the pancreas
91
Jejunal branches
Superior mesenteric artery
Supply Jejunum
92
Ileal branches
Superior mesenteric artery
Supply ileum
93
Ileocolic artery
Superior mesenteric artery
Supplies caecum, appendix and ascending colon
94
Right colic artery
Superior mesenteric artery
Supplies ascending colon
95
Middle colic artery
Superior mesenteric artery
Supplies transverse colon
96
Arcades
Jejunal and ileal branches embedded in the mesentery in the small intestine
Anastomose with each other forming loops
97
Vasa recta
Straight vessels that run from the arcades to supply the intestinal wall
98
Inferior mesenteric artery leaves aorta at level of
L3
99
Inferior mesenteric artery
Smaller calibre vessel than other 2 branches of aorta
100
Inferior mesenteric artery supplies
Hindgut
Distal 1/3 supplies the transverse colon, descending and sigmoid colon, rectum, upper part of anal canal
101
Left colic artery
Inferior mesenteric artery
Supplies the transverse colon and descending colon
102
Sigmoid branches
Inferior mesenteric artery
Supply the sigmoid colom
103
Superior rectal artery
Terminal branch of the Inferior mesenteric artery
Supplies the rectum
104
Marginal artery
Branches of the middle colic artery and. Left colic artery anastomose along distal 1/3 of colo. and splenic flexure
105
Arterial supply to rectum
Superior rectal artery- inferior mesenteric artery terminal branch
also supplied by middle and inferior rectal arteries which branch from the internal iliac arteries in the pelvis. The middle and inferior rectal arteries anastomose with branches of the superior rectal arteries.
106
Middle and inferior rectal arteries
Branches from the internal iliac arteries
107
Inferior mesenteric vein
Accompanies the inferior mesenteric artery
Drains the hindgut
Ascends on left side of the abdomen and typically drains into the splenic vein
108
Venous blood of the rectum
Drains into the portal system via the inferior mesenteric vein and into the systemic system via the internal iliac veins
109
Superior mesenteric vein
Accompanies the superior mesenteric artery
Drains the midgut
Ascends and unites with the splenic vein close to the liver to form the hepatic portal vein
110
Hepatic portal vein
Enters the liver
After the nutrients are removed from the blood, it enters small hepatic veins, which unite within the liver to form two or three large hepatic veins that enter the IVC as it passes posterior the liver
111
Parasympathetic fibres to the foregut and midgut
Vagus nerve
112
Parasympathetic fibres to the hindgut
Pelvic splanchnic nerves
113
Pelvic splanchnic nerves
Formed by the axons of parasympathetic neurons that lie in the sacral spinal cord (S2-S4)
convey parasympathetic fibres to the pelvic viscera and hindgut
114
Sympathetic fibres to the foregut
Greater splanchnic nerve
T5-T9
115
Sympathetic fibres to the midgut
Lesser splanchnic nerve
T10-T11
116
Sympathetic fibres to the hindgut
Least splanchnic nerve
T12
117
visceral sensory fibres that travel with sympathetic nerves convey
Painful sensations
118
visceral sensory fibres that travel with parasympathetic nerves convey
information that maintains the internal environment and elicits reflex responses
119
Somatic sensory information from the upper abdomen and Epigastrium
Dermatomes T5-T9
120
Somatic sensory information from the umbilical region
Dermatomes T10-T11
121
Somatic sensory information from the suprapubic region
Dermatomes T12
122
Pain from the abdominal viscera is referred to the body wall: Epigastrium
Foregut pathology
123
Pain from the abdominal viscera is referred to the body wall: umbilical region
Midgut pathology
124
Pain from the abdominal viscera is referred to the body wall: suprapubic region
Hindgut pathology
125
Appendicitis
Inflammation of the appendix is appendicitis and is a common acute surgical presentation. The pain of appendicitis typically begins in the umbilical region and is poorly localised. This is the result of irritation of the visceral peritoneum (visceral sensory afferents returning to spinal cord segment T10). As inflammation progresses, the adjacent parietal peritoneum becomes involved. This causes severe, well localised pain in the right iliac fossa (which is conveyed to the CNS via somatic nerves that innervate the body wall). Therefore the history is of diffuse umbilical pain that ‘moves’ to the right iliac fossa. Symptoms can vary, depending on where the tip of the appendix lies. Tenderness is maximal over McBurney’s point. Rupture of the appendix can lead to peritonitis. Removal of the appendix (appendicectomy) is usually performed via laparoscopy (‘keyhole’ surgery).
126
Mesenteric ischaemia
Just like the coronary arteries, the mesenteric vessels may be occluded by a thrombus. This results in ischaemia of the intestine which may progress to infarction. Acute mesenteric ischaemia is a surgical emergency. The gut must be revascularized and any sections of necrotic intestine must be removed. Mortality is high, even when the condition is recognised and treated.
127
Inflammatory bowel disease
Crohn’s disease and ulcerative colitis are two types of inflammatory bowel disease.
Crohn’s disease is characterised by inflammation of the gut mucosa. It can affect any part of the GI tract but typically affects the small intestine. Patients suffer with symptoms including abdominal pain, diarrhoea, bloody stools, weight loss and tiredness. Ulcerative colitis affects the colon and rectum. The mucosa becomes inflamed and ulcerated. Patients suffer with abdominal pain, bloody diarrhoea, weight loss and tiredness. Flare-ups of both diseases can be serious and may lead to life-threatening complications. If medications fail to control symptoms, the affected part of the gut may be removed.
128
Colon cancer
Cancer of the colon (often called bowel cancer) is common in the UK. The main symptoms of colon cancer are a change in bowel habit, blood in the stools and abdominal pain or bloating. Colonoscopy allows visualisation of the colon and biopsies can be taken if a mass is seen.
129
Volvulus
Volvulus is twisting of the gut. It affects parts of the gut that are mobile (i.e. have a mesentery) and is most common at the sigmoid colon. Twisting obstructs the passage of faeces and may cause ischaemia and infarction of the affected part of the gut.
130
Rugae
ridges that increase the surface area of the stomach and stretch out to increase stomach volume when the stomach is full
131
Where are gastric rugae most prominent
gastric rugae are most prominent along the greater curvature
132
Role of greater omentum
prevents the parietal and visceral peritoneum of the abdominal cavity from adhering to each other. For example, it prevents the parietal peritoneum lining the anterior abdominal wall from sticking to the visceral peritoneum of the ileum.
133
Haustra
characteristic ‘bulges’ of the large intestine.
134
Teniae coli
longitudinal bands of smooth muscle in large intestine
135
Epipolic appendages
fatty tags on the external surface of the large intestine. There are typically few on the ascending and descending colon, but usually many on the transverse and sigmoid colon.
136
Function of haustral folds
saccules in the colon that give it its segmented appearance. Haustral contraction is activated by the presence of chyme and serves to move food slowly to the next haustra, along with mixing the chyme to help with water absorption
137
Where are haustral folds found
Large intestine
138
Where are plicae circularis found
Small intestine
139
Urachus
Connects bladder to umbilicus in fetus
140
Which anatomical landmark indicates the beginning of the oesophagus
Cricoid cartilage
141
Where does the transverse mesocolon lie
Between the colic flexures
142
Which portion of the duodenum contains the opening of the major duodenal papilla
Descending (2nd part)
143
The greater omentum is attached to which parts of the GI tract
Stomach
Transverse colon
144
Pain sensation from foregut structures is carried by which nerve
Greater splanchnic nerve (T5-T9)
145
Is the appendix a foregut, midgut or Hindgut structure
Midgut
146
Which artery supplies the ascending colon
Right colic artery
147
Which structures are found in the large intestine
Haustra
Teniae coli
Epiploic appendages
148
Which arteries supply the duodenum
Gastroduodenal
Inferior pancreaticoduodenal
149
What supplies the Fundus of the stomach
Short gastric artery
150
Short gastric artery
Branch of splenic artery
Supplies Fundus of stomach
