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GI anatomy > The Stomach And The Small And Large Intestine > Flashcards

The Stomach And The Small And Large Intestine Flashcards

1
Q

At what level is the oesophageal hiatus in the diaphragm

A

T10

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2
Q

Length of abdominal segment of oesophagus

A

Less than 2cm

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3
Q

Muscle around the oesophageal hiatus

A

Functions as a sphincter that prevents reflux of the stomach contents into the oesophagus

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4
Q

Arterial supply of distal oesophagus

A

Branches of the left gastric artery

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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

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6
Q

Distal oesophagus to portal venous system

A

Via left gastric veins

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7
Q

Shape of stomach

A

J-shaped that expands to accommodate food and fluid

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8
Q

Distal oesophagus to azygos vein system

A

Via oesophageal veins

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9
Q

What does the stomach break food down into

A

Chyme

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10
Q

4 parts of the stomach

A

Cardia
Fundus
Body
Pylorus

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11
Q

Cardia of the stomach

A

Continuous with the oesophagus

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12
Q

Fundus of the stomach

A

Most superior part
Lies superior to the level of entry of the oesophagus
Usually filled with gas

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13
Q

Body of the stomach

A

Largest part

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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

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15
Q

Pyloric sphincter

A

Formed of circular smooth muscle
Regulates the passage of chyme into the duodenum

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16
Q

Why border of the stomach has greater curvature

A

Longer left border

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17
Q

Which quadrant does the stomach lie in

A

Left upper quadrant

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18
Q

What is the anterior surface of the stomach related to

A

Anterior abdominal wall
Diaphragm
Left lobe of liver

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19
Q

What does the posterior wall of the stomach form

A

Anterior wall of the lesser sac

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20
Q

Lesser omentum

A

Connects the lesser curvature to the liver

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21
Q

What does the free edge of the lesser omentum contain

A

Hepatic artery
Hepatic portal vein
Bile duct

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22
Q

Greater omentum

A

Hangs from the greater curvature of the stomach

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23
Q

Arterial supply to the stomach

A

Arteries that branch from the coeliac trunk

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24
Q

What does the foregut comprise

A

Stomach, first 1/2 of duodenum, liver, gallbladder, pancreas

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25
Q

What does the coeliac trunk supply

A

Viscera that are derived from the embryonic foregut and the spleen

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26
Q

At what level of vertebrae does the coeliac trunk branch from the anterior aspect of the abdominal aorta

A

T12

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27
Q

Embryonic origins of the spleen

A

Develops in the dorsal mesentry
Mesodermal in origin

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28
Q

3 branches of the coeliac trunk

A

Left gastric artery
Common hepatic artery
Splenic artery

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29
Q

Left and right gastric arteries

A

Run along lesser curvature of the stomach and anastomose with each other

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30
Q

What does the left gastric artery arise from

A

Coeliac trunk

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31
Q

What does the right gastric artery arise from

A

Either the common hepatic artery or the hepatic artery proper

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32
Q

Left and right gastro-omental arteries

A

Run along the greater curvature of the stomach and anastomose with each other

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33
Q

What does the left gastro-omental artery arise from

A

Splenic artery

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34
Q

What does the right gastro-omental artery arise from

A

Gastroduodenal artery (a branch of the common hepatic artery)

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35
Q

What do the right and left gastric veins and the right and left gastro-omental veins drain into

A

Hepatic portal vein

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36
Q

Parasympathetic stimulation of the stomach

A

Vagus nerve
Promotes peristalsis and gastric secretion

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37
Q

Sympathetic innervation of the stomach

A

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

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38
Q

Hiatus hernia

A

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).

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39
Q

Gastric ulcer

A

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.

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40
Q

Pyloric stenosis

A

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.

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41
Q

Is pyloric stenosis more common in boys or girls

A

Boys

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42
Q

At what age does pyloric stenosis typically present

A

6 weeks after birth

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43
Q

Gastric cancer

A

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.

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44
Q

3 parts of the small intestine

A

Duodenum
Jejunum
Ileum

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45
Q

What is the duodenum continuous with

A

Pylorus of the stomach

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46
Q

Shape of duodenum

A

Short and curved into a C-shape around the head of the pancreas

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47
Q

Is the duodenum retroperitoneal or intraperitoneal

A

Most of the length is retroperitoneal

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48
Q

Major duodenal papilla

A

Opening of the bile duct and main pancreatic duct
1/2 along internal wall of duodenum

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49
Q

Embryological origins of first 1/2 of duodenum

A

Embryological foregut

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50
Q

Embryological origins of second 1/2 of duodenum

A

Embryological midgut

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51
Q

Arterial supply to the first 1/2 of duodenum

A

Arterial branches of the coeliac trunk

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52
Q

Arterial supply to the second 1/2 of duodenum

A

Superior mesenteric artery

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53
Q

Are the Jejunum and ileum retroperitoneal or intraperitoneal

A

Intraperitoneal
Suspended from the posterior abdominal wall by the mesentery of the small intestine

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54
Q

What are the Jejunum and ileum derived from

A

Embryological midgut

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55
Q

Mesentery

A

Posterior wall

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56
Q

How is the Jejunum and ileum adapted for nutrient absorption

A

Vast surface area:
Long
Plicae circulares = mucosa is folded
Villi and microvilli

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57
Q

Differences between Jejunum and ileum

A

Plicae are more pronounced in Jejunum
Internal ileum characterised by Peyer’s patches (large submucosal lymph nodules)

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58
Q

Peyer’s patches

A

Large submucosal lymph nodules in ileum

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59
Q

Plicae circulares

A

Folds of the small intestine mucosa

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60
Q

Meckel’s diverticulum

A

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

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61
Q

Inflammation of the Meckel’s diverticulum

A

May mimic appendicitis

62
Q

Ileocaecal junction

A

Terminal ileum is continuous with the caecum
In right iliac fossa

63
Q

Role of large intestine

A

Reabsorbs water for faecal material to form semi-solid faeces

64
Q

What is the large intestine composed of

A

caecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anal canal.

65
Q

Taeniae coli

A

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
Q

Haustra

A

Bulges formed by the inner circular muscle layer of the large intestine

67
Q

Epiploic appendages

A

Fatty tags that mark the point at which blood vessels penetrate the intestinal wall of the large intestine

68
Q

Caecum

A

First part of the large intestine
Distended, blind-ended pouch
Covered by the peritoneum but does not have a mesentery

69
Q

Appendix

A

A small diverticulum that arises from the caecum
Contains lymphoid tissue
Varies in length

70
Q

McBurney’s point

A

Surface marking of the base of the appendix

71
Q

Mesoappendix

A

Small mesentery which connects the appendix to the caecum

72
Q

Ascending colon

A

Continuous with caecum
Runs vertically on right side of posterior abdominal wall on right paracolic gutter

73
Q

Is the ascending colon retroperitoneal or intraperitoneal

A

It is a secondarily retroperitoneal organ

74
Q

Hepatic flexure (right colic flexure)

A

ascending colon makes a 90 degree turn left in the right upper quadrant, becoming continuous with the transverse colon

75
Q

Transverse colon

A

Continuous with ascending colon
Runs horizontally in the abdomen but often hangs inferiorly

76
Q

Transverse mesocolon

A

Suspends the transverse colon from the posterior abdominal wall

77
Q

Is the transverse colon retroperitoneal or intraperitoneal

A

Intraperitoneal

78
Q

Splenic flexure (left colic flexure)

A

transverse colon makes a 90 degree turn inferiorly in the left upper quadrant, becoming continuous with the descending colon.

79
Q

Phrenicocolic ligament

A

Tethers to splenic flexure to the diaphragm

80
Q

Embryological development of the transverse colon

A

proximal (first) two thirds develop from the embryological midgut, whilst the distal (last) third develops from the embryological hindgut

81
Q

Descending colon

A

Continuous with the transverse colon
Runs vertically on the left side of the posterior abdominal wall in the left paracolic gutter

82
Q

Is the descending colon retroperitoneal or intraperitoneal

A

Secondarily retroperitoneal organ

83
Q

Sigmoid colon

A

Lies in left lower quadrant
Continuous with descending colon and rectum

84
Q

Rectosigmoid junction

A

As the sigmoid approaches the midline, it makes a 90 degree turn inferiorly into the pelvis

85
Q

Sigmoid mesentery

A

Sigmoid colon has a mesentery
It is intraperitoneal

86
Q

Rectum

A

Lies in the pelvis
Continuous with rectosigmoid junction and anal canal
Stores faeces

87
Q

Is the rectum retroperitoneal or intraperitoneal

A

Retroperitoneal

88
Q

At what level of the rectosigmoid junction

A

S3

89
Q

Superior mesenteric artery leaves aorta at level of

A

L1

90
Q

Superior mesenteric artery supplies

A

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
Q

Jejunal branches

A

Superior mesenteric artery
Supply Jejunum

92
Q

Ileal branches

A

Superior mesenteric artery
Supply ileum

93
Q

Ileocolic artery

A

Superior mesenteric artery
Supplies caecum, appendix and ascending colon

94
Q

Right colic artery

A

Superior mesenteric artery
Supplies ascending colon

95
Q

Middle colic artery

A

Superior mesenteric artery
Supplies transverse colon

96
Q

Arcades

A

Jejunal and ileal branches embedded in the mesentery in the small intestine
Anastomose with each other forming loops

97
Q

Vasa recta

A

Straight vessels that run from the arcades to supply the intestinal wall

98
Q

Inferior mesenteric artery leaves aorta at level of

A

L3

99
Q

Inferior mesenteric artery

A

Smaller calibre vessel than other 2 branches of aorta

100
Q

Inferior mesenteric artery supplies

A

Hindgut
Distal 1/3 supplies the transverse colon, descending and sigmoid colon, rectum, upper part of anal canal

101
Q

Left colic artery

A

Inferior mesenteric artery
Supplies the transverse colon and descending colon

102
Q

Sigmoid branches

A

Inferior mesenteric artery
Supply the sigmoid colom

103
Q

Superior rectal artery

A

Terminal branch of the Inferior mesenteric artery
Supplies the rectum

104
Q

Marginal artery

A

Branches of the middle colic artery and. Left colic artery anastomose along distal 1/3 of colo. and splenic flexure

105
Q

Arterial supply to rectum

A

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
Q

Middle and inferior rectal arteries

A

Branches from the internal iliac arteries

107
Q

Inferior mesenteric vein

A

Accompanies the inferior mesenteric artery
Drains the hindgut
Ascends on left side of the abdomen and typically drains into the splenic vein

108
Q

Venous blood of the rectum

A

Drains into the portal system via the inferior mesenteric vein and into the systemic system via the internal iliac veins

109
Q

Superior mesenteric vein

A

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
Q

Hepatic portal vein

A

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
Q

Parasympathetic fibres to the foregut and midgut

A

Vagus nerve

112
Q

Parasympathetic fibres to the hindgut

A

Pelvic splanchnic nerves

113
Q

Pelvic splanchnic nerves

A

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
Q

Sympathetic fibres to the foregut

A

Greater splanchnic nerve
T5-T9

115
Q

Sympathetic fibres to the midgut

A

Lesser splanchnic nerve
T10-T11

116
Q

Sympathetic fibres to the hindgut

A

Least splanchnic nerve
T12

117
Q

visceral sensory fibres that travel with sympathetic nerves convey

A

Painful sensations

118
Q

visceral sensory fibres that travel with parasympathetic nerves convey

A

information that maintains the internal environment and elicits reflex responses

119
Q

Somatic sensory information from the upper abdomen and Epigastrium

A

Dermatomes T5-T9

120
Q

Somatic sensory information from the umbilical region

A

Dermatomes T10-T11

121
Q

Somatic sensory information from the suprapubic region

A

Dermatomes T12

122
Q

Pain from the abdominal viscera is referred to the body wall: Epigastrium

A

Foregut pathology

123
Q

Pain from the abdominal viscera is referred to the body wall: umbilical region

A

Midgut pathology

124
Q

Pain from the abdominal viscera is referred to the body wall: suprapubic region

A

Hindgut pathology

125
Q

Appendicitis

A

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
Q

Mesenteric ischaemia

A

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
Q

Inflammatory bowel disease

A

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
Q

Colon cancer

A

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
Q

Volvulus

A

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
Q

Rugae

A

ridges that increase the surface area of the stomach and stretch out to increase stomach volume when the stomach is full

131
Q

Where are gastric rugae most prominent

A

gastric rugae are most prominent along the greater curvature

132
Q

Role of greater omentum

A

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
Q

Haustra

A

characteristic ‘bulges’ of the large intestine.

134
Q

Teniae coli

A

longitudinal bands of smooth muscle in large intestine

135
Q

Epipolic appendages

A

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
Q

Function of haustral folds

A

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
Q

Where are haustral folds found

A

Large intestine

138
Q

Where are plicae circularis found

A

Small intestine

139
Q

Urachus

A

Connects bladder to umbilicus in fetus

140
Q

Which anatomical landmark indicates the beginning of the oesophagus

A

Cricoid cartilage

141
Q

Where does the transverse mesocolon lie

A

Between the colic flexures

142
Q

Which portion of the duodenum contains the opening of the major duodenal papilla

A

Descending (2nd part)

143
Q

The greater omentum is attached to which parts of the GI tract

A

Stomach
Transverse colon

144
Q

Pain sensation from foregut structures is carried by which nerve

A

Greater splanchnic nerve (T5-T9)

145
Q

Is the appendix a foregut, midgut or Hindgut structure

A

Midgut

146
Q

Which artery supplies the ascending colon

A

Right colic artery

147
Q

Which structures are found in the large intestine

A

Haustra
Teniae coli
Epiploic appendages

148
Q

Which arteries supply the duodenum

A

Gastroduodenal
Inferior pancreaticoduodenal

149
Q

What supplies the Fundus of the stomach

A

Short gastric artery

150
Q

Short gastric artery

A

Branch of splenic artery
Supplies Fundus of stomach

GI anatomy (5 decks)

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