UGI Flashcards

1
Q

where are the openings in the diaphragm located?

A

Caval = T8

Oesophageal = T10

Aortic = T12

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2
Q

What passes through the caval opening?

A

Caval

  • IVC
  • right phrenic
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3
Q

What passes through the oesophageal opening ?

A

Oesophageal

  • oesophagus
  • vagus
  • oesophageal branches of left gastric
  • lymphatics
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4
Q

What passes through the aortic opening?

A

Aortic

  • aorta
  • azygos vein
  • thoracic duct
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5
Q

What passes through the ligaments?

A

Medial

  • sympathetic chain
  • phrenic

lateral

  • quadratus lumborum
  • subcostal neurvascular bundle
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6
Q

What is the blood supply to the diaphragm?

A
  • inferior phrenic (first branch of abdominal aorta)
  • superior phrenic (branch of thoracic aorta)
  • pericardiophrenic (internal thoracic)
  • lower 5 intercostal arteries
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7
Q

What is the embryological origin of the diaphragm?

A

4 structures

  1. septum transversum - anterior (Morgagni hernia)
  2. pleuroperitoneal membrane - muscular part
  3. body wall muscles - muscular part
  4. mesentry of oesophagus - crura
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8
Q

What is the anatomy of the upper oesophageal sphincter?

A

Comprised of three muscles

  • cricopharyngeus (main)
  • thyropharyngeus
  • Upper oesophagus

In a state of tonic contraction between swallowing

Prevents reflux of contents into lungs and air into oesophagus (distension)

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9
Q

What is the anatomy of the lower oesophageal sphincter (ie what are factors preventing against GORD)?

A

The lower esophageal sphincter is a physiological sphincter with a high pressure zone.

MALT are the factors contributing to the sphincter

Muscle

  • The muscle in this region normally remains tonically contracted except when swallowing (alcohol relaxes it).

Angle of His

  • the angle of entry to the stomach (cardiac incisure; angle of His) can result in a flap-like closure of the lower esophageal entry when the stomach is full.

Length

  • the lower 2 cm of the esophagus is in the abdomen, where intra-abdominal pressure can help keep it closed.

Twirl

  • Right crus loops around oesophagus
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10
Q

What are the layers of the oesophagus?

A
  1. mucosa
  2. submucosa
  3. muscularis

There is NO sersoa. Beause of this oesophageal cancer spreads early.

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11
Q

What is the blood supply to the oesophagus?

A

Oesophagus Part

Arterial

Venous

Parasympathetic

Sympathetic

Upper

Inferior thyroid

Brachiocephalic

Recurrent laryngeal

Middle cervical ganglion

Middle

Thoracic aorta

Azygous veins

Lower

Left gastric

Inferior phrenic

Left gastric vein ® portal vein

Vagus (oesophageal plexus) = motor. LARP.

Greater splanchnic, sympathetic trunks

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12
Q

Where does the oesophagus start and end?

A
  • The oesophagus is a muscular tube measuring approximately 25 cm in length
  • Divided into 3 parts - cervical, thoracic and intra-abdominal
  • commences at C6 (pharyngo-oesophageal junction)
  • enters abdomen at T10 diaphragmmatic hiatus
  • ends at about T11
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13
Q

What is the lymphatic drainage of the oesophagus and how is this clinically relevant?

A
  • Upper third = deep cervical nodes
  • middle third = mediastinal nodes
  • lower third = gastric and coeliac nodes
  • There is a RICH SUBMUCOSAL LYMPHATIC NETWORK
  • interconnections among these three drainage regions (bi-directional flow)

Clinical relevance

  • The bidirectional lymph flow, rich submucosal network and lack of a serosa is responsible for the spread of malignancy from the lower esophagus to the upper esophagus.
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14
Q

Where does the thoracic duct start, cross the midline and end?

A

starts

  • T12 vertebrae as continuation of the cisterna chyli
  • ascends posterior to right crus of diaphragm, to right of aorta and oesophagus

crosses midline

  • T5 level slopes to the left to cross midline
  • ascends superficial to azygos and intercostal arteries

ends

  • crosses over dome of left pleura
  • passes medial to scalenus anterior
  • enters confluence of left IJV and left subclavian
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15
Q

What does the thoracic duct drain?

A

everything in the body except right head/neck/thorax and upper limb

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16
Q

Where is the thoracic duct most at risk during oesophageal mobiliztion?

A
  1. arch of the azygos vein
  2. arch of the aorta
17
Q

How does the upper gastric remnant survive after a near total gastrectomy?

A

Survives due to rich intramural arterial anastomosis in its submucosal layer which is continous with a network in the submucosa of the stomach.

18
Q

What is the ligament of Treitz?

A
  • It is the suspensory muscle of duodenum
  • Smooth muscle and elastic fibers from the right diaphragmatic crus to parts 3 and 4 of the duodenum constitute the suspensory muscle of the duodenum (so-called “Ligament of Treitz”).
19
Q

which part of the duodenum is covered with peritoneum?

A
  • The first 2cm of D1 has a mesentery.
  • This dilated section of the duodenum is called the duodenal cap and is intraperitoneal.
  • The rest of the duodenum is retroperitoneal.