Upper GI anatomy Flashcards by Shahana Sengupta

What kind of epithelium is the mucosa present in the oral cavity? Which portion is keratinised?

stratified squamous epithelium
keratinised: gum, hard palate and dorm of tongue
non-keratinised: lips and cheeks

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What are the 2 parts of the oral cavity?

vestibule

oral cavity proper

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Where is the oral cavity proper?

the space internal to the teeth

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Where is the vestibule?

‘slit-like’ space external to teeth and between the gums

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Which muscles is the oral cavity bound by?

buccinator muscle

left and right

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Which duct pierces the buccinator muscle?

Parotid duct

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Which other muscle are the buccinator muscles closely associated with?

superior constrictor muscles

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What do the buccinator and superior constrictor muscles attach to?

pterygoid manibular raphe

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Which fat pad lies superficially to the buccinator muscle and is often large in babies?

buccal fat pad

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Which muscles form the floor of the mouth?

mylohyoid

geniohyoid

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What structure occupies most of the floor of the mouth?

Tongue

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The roof of the mouth is occupied by the palate which has 2 main parts:

soft palate

hard palate

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Which 5 muscles compose the soft palate?

musculus uvula
palatoglossus
palatopharyngeus
levator veli palatine
tensor veli palatine

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The muscles in the soft palate are all supplied by the vagus nerve, except for the tensor veil palatine which is supplied by what?

mandibular division of the trigeminal nerve

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Which structure assists in the equalisation of air pressure?

Auditory tube

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What are the 2 folds present in the back of the oral cavity? Descibe their relative anatomical position.

palatoglossal fold - anterior

palatopharyngeal fold - posterior

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The hard palate are composed of which 2 bones?

maxilla

palatine bone

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What do the lesser palatine nerves supply?

soft palate
tonsils (palantine)
uvula

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What is the tongue important for?

speech, mastication, swallowing and taste

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What are the main regions of the tongue?

dorsum tip, inferior surface and root

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The oral and pharyngeal portions of the tongue are separated by what structure?

Terminal sulcus

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The oral portion of the tongue comprises:

the anterior two thirds

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The pharyngeal portion of the tongue comprises:

the posterior one third

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Which nerve supplies general sensation of the oral segment of the tongue?

Lingal branch of V3

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Which nerve supplies taste sensation of the oral segment of the tongue?

Facial nerve

Which nerve supplies general and taste sensation of the pharyngeal segment of the tongue?

glossopharyngeal nerve

What does the root of the tongue attach to?

hyoid bone and mandible

What are the 3 types of papilla found on the surface of the tongue?

fungiform filiform valiate

Which 4 extrinsic muscles make up the tongue?

palatoglossus styloglossus hyoglossus Genioglossus

What nerve supplies all but the palatoglossus muscle of the tongue?

hypoglossal nerve

Which nerve supplies the palatoglossus muscle of the tongue?

pharyngeal plexus (of the vagus nerve)

What is the clinical significance of the valleculae?

These are mucosal pouches, which are an important landmark for endotracheal intubation

What is the blood supply to the tongue?

Lingal artery

What is the lymphatic drainage of the tongue?

deep cervical nodes

Which is the largest salivary gland?

Parotid

Where does the parotid gland sit?

On the masseter muscle

What are the 3 salivary glands?

Parotid sub-mandibular sub-lingal

The duct of which gland opens into the mouth lateral to the frenulum?

submandibular gland

What is the frenulum?

slip of tissue that runs vertically from the floor of the mouth to tongue

Where do the sublingual glands lie?

On the floor of the oral cavity between the mandible and the genioglossus muscle

Where and what is the pharynx?

A fibro-muscular tube attached to the base of the skull superiorly and continuous with the oesophagus inferiorly

What are the 3 segments of the pharynx?

nasopharynx oropharynx laryngopharynx

What vertebral level does the nasopharynx lie?

C1-C2

What vertebral level does the oropharynx lie?

C2-C3

What vertebral level does the laryngopharynx lie?

C4-C6

What are the structures present in Waldeyer's ring?

2 tubal tonsils 2 palatine tonsils group of lingual tonsils

What is the blood supply for the palatine tonsils?

facial artery

What is the function of the epiglottis?

Contraction during eating to block off the trachea and therefore prevent food from getting stuck causing aspiration

The posterior wall of the pharynx is enclosed by which 3 constrictor muscles?

superior, middle, inferior

Which nerve supplies the constrictor muscles?

Vagus

What is Charcot's triad? What should be done?

``` = surgical emergency includes: - fever - RUQ pain - jaundice ``` Patients need: Biliary decompression and broad spectrum antibiotics. ERCP = Endoscopic retrograde cholangiopancreatography usually after 72 hours of antibiotics Percutaneous transhepatic cholangiogram and biliary drain

Where does the superior mesenteric vein drain into prior to the IVC?

SVM first anastomoses with the portal vein | which then drains into the IVC

Direct inguinal hernias travel through Hesselach's triangle. What are its main borders?

Superolaterally: epigastric vessels medially: lateral edge of rectus abdomens inferiorly: inguinal ligament

Which are the retroperitoneal organs?

``` Suprarenal glands (adrenal) Aorta/IVC Duodenum (2nd and 3rd fragments) Pancreas Ureters Colon (ascending and descending only) Kidneys Esophagus Rectum ```

What artery is at risk of ulceration with a posterior duodenal ulcer?

gastroduodenal artery

What is the risk with anterior duodenal ulcers?

no risk of haemorrhage since there is no artery overlying the anterior surface? more at risk of pneumoperitoneum

What level is the transplyloric plane?

What is found at the transpyloric plane?

- pylorus of stomach - left kidney hilum (think L1 = Left one) - right hilum of kidney (1.5cm lower than L kidney) - fundus of gallbladder - neck of pancreas - duodeno-jejunal flexure - SMA - portal vein - left and right colic flexure - root of the transverse mesocolon - D2 of duodenum - spleen

What is the blood supply to a Meckel's diverticulum?

Vitelline artery | embryological orgin of Meckel's is the vitello-ileal pouch

What is an ANNULAR pancreas?

rare condition the second part of the duodenum is surrounded by a ring of pancreatic tissue this is continuous with the head of the pancreas. This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines.

In patients with annular pancreas, where is the mostly likely site of obstruction?

D2 (second part) of duodenum

At what level does the portal vein begin?

L1 | begins at the transpyloric plane

Into which vein does the IMV drain (usually)?

splenic vein

Where does the anastomosis between IMV and splenic vein lie?

Close to the duodenum near plane of splenic flexure

What structure lies most posteriorly at the porta hepatis?

portal vein

What is the common bile duct?

= continuation of common hepatic duct | - formed by union of common hepatic duct and cystic duct

What are the contents of the PORTA HEPATIS?

- common hepatic duct - hepatic artery - portal vein - sympathetic and parasympathetic nerves - lymphatic drainage of liver (LNs)

What are the 3 main ligaments in the liver?

- falciform ligament - ligamentum teres - ligamentum venosum

What is the falciform ligament?

- 2 layer fold peritoneum from the umbilicus to the anterior liver surface - splits into the coronary and left triangular ligaments - contains ligamentum teres

What is the ligamentum teres?

- remnant of umbilical vein | - joins left branch of portal vein in porta hepatis

What is the ligamentum venosum?

remnant of ductus venosus

What is the nerve supply to the liver?

SNS and PNS trunks from the coeliac plexus

What are the 2 main muscles of the abdominal wall?

ANTERIOR rectus abdominus POSTERIOR quadratus lumborum

What are the 3 muscular middle layers of the abdominal wall?

- external oblique - internal oblique - transverse abdominus

Where does the external carotid start?

immediately lateral to the pharyngeal side wall

Where does the external carotid terminate?

pierces fascia of parotid gland | then divides into terminal branch within gland

Which structure lies posterolaterally to the external carotid at its origin from the common carotid?

internal carotid artery

What structure separates the subclavian artery and vein?

anterior scalene muscle subclavian vein: anterior subclavian artery: posterior