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Gastrointestinal System > Week 1 - Endoscopic Tour > Flashcards

Week 1 - Endoscopic Tour Flashcards

1
Q

In endoscopy, what marks the start of the oesophagus?

A

Cricopharyngeal sphincter

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2
Q

How far is the oesophagogastric mucosal junction usually from the incisor teeth in an adult?

A

38-40cm

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3
Q

What is barretts’s oesophagus?

A

Reflux of stomach acid has caused metaplasia of oesophageal epithelium to gastric columnar epithelium

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4
Q

What are oesophageal varicies?

A

Swollen veins in oesophagus caused by portal hypertension, these may rupture and bleed

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5
Q

How can portal hypertension occur?

A

Blocked vessels in liver

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6
Q

What is dysphagia?

A

Swallowing problems

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7
Q

What is achalasia?

A

Muscles in lower part of oesophagus fail to relax, preventing food from passing into stomach

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8
Q

What is benign stricture?

A

Diameter of oesophagus narrowed by scar tissue formation

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9
Q

What structures reduce stomach acid reflux?

A

Lower oesophageal sphincter

Acute angle of entry of oesophagus into stomach produces valve like effect

Mucosal folds at oesophagogastic junction acts as valve

Diaphragm acts as pinch cock

Positive intra-abdominal pressure compresses walls of intra-abdominal oesophagus

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10
Q

What controls passage of stomach contents into duodenum?

A

Pyloric sphincter

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11
Q

Where is gastric ulceration most commonly found in the stomach?

A

On the lesser curve at angulus

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12
Q

What is the duodenojejunal flexure supported by?

A

Ligament of treitz

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13
Q

Where does the duodenum start and finish?

A

Starts at L1, curves round and ends at L2-3

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14
Q

Where does it sit with respect to the peritoneum?

A

Starts intraperitoneally

Becomes retroperitoneal

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15
Q

How many divisions are there in the duodenum?

A

4

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16
Q

How long is the first part of the duodenum?

A

5cm

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17
Q

How can gallstones affect the first part of the duodenum?

A

Its overlapped by the gallbladder and gallstones may cause erosion through leading to coledocoduodenal fistula

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18
Q

Where are duodenal ulcers most commonly located?

A

First part

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19
Q

What damage may an anterior ulcer cause?

A

May perforate causing peritonitis

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20
Q

What damage may a posterior ulcer cause?

A

May erode into gastroduodenal artery or into pancreas

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21
Q

How long is the second section of the duodenum?

A

7.5cm

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22
Q

What structures are related to 2nd section of duodenum?

A

Wraps around head of pancreas

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23
Q

Where is the major duodenal papilla and what is its significance?

A

Lays half way along posteromedial aspect of 2nd part of duodenum

Signifies opening of main pancreatic duct

Transition from embryonic foregut to midgut occurs here

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24
Q

What do ulcers in the 2nd section of duodenum suggest?

A

Pancreatic disease or zollinger-ellison syndrome

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25
Q

What is zollinger-ellison syndrome?

A

Either gastrin secretion tumour or hyperplasia of islet cells in pancreas causing over production of gastric acid

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26
Q

How long is the third section of the duodenum?

A

10cm

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27
Q

Where is the third section of the duodenum located?

A

Runs transversely at level of L2/3

Crosses aorta below origin of superior mesenteric artery

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28
Q

What may happen in patients with a diseased duodenum or aorta?

A

Development of aorto-duodenal fistula

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29
Q

What runs anterior and posterior to the third section of the duodenum?

A

Anterior - superior mesenteric artery

Posterior - aorta

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30
Q

What may occur to the duodenum in patients with dramatic weight loss?

A

May develop SMA syndrome where duodenal obstruction is caused by compression by superior mesenteric artery and aorta

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31
Q

How long is the 4th section of the duodenum?

A

2.5cm

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32
Q

At which point does the duodenum become intraperitoneal?

A

At the duodenojejunal flexure

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33
Q

What marks the duodenojejunal flexure?

A

The suspensory ligament of treitz

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34
Q

Where does the Hillary tree start and what does it form?

A

Commences wishing the liver from intrahepatic ducts, which form left and right common bile ducts

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35
Q

What is the common hepatic duct formed by?

A

Convergence of the left and right hepatic ducts at porta hepatic

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36
Q

How long is the common hepatic duct?

A

4cm

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37
Q

The cystic duct arising from gallbladder joins common hepatic duct to form what?

A

Common bile duct

38
Q

How long and wide is the common bile duct?

A

10cm long

Up to 7cm in diameter

39
Q

What will blockage of the common bile duct lead to?

A

Obstruction of bile flow
Jaundice
Disruption to enterohepatic circulation of bile salts

40
Q

What will patients with a blocked common bile duct present with?

A

Yellow discolouration
Dark urine
Pale stool

41
Q

What is the most common cause of painless obstructive jaundice?

A

Secondary to tumour

42
Q

What is the most common tumour to cause obstructive jaundice?

A

Carcinoma of head of pancreas, obstructs common bile duct as it passes either through or in close relation to head of pancreas

43
Q

What is the most common cause of painful obstructive jaundice?

A

Gallstone disease

44
Q

Where does the common bile duct run?

A

Superior to duodenum, runs in free edge of lesser momentum along with portal vein and hepatic artery

45
Q

How long is the small intestine?

A

Varies from 3-10m

46
Q

What is the small intestine divided into and what are their proportions?

A

Jejunum - about 2/5

Ileum - about 3/5

47
Q

How is the jejunum wall different to the wall of ileum?

A

Thicker due to increased number, larger and taller pillage circulates (circular folds of mucosa)
Also appears deeper red due to greater blood supply

48
Q

Describe jejunal wall

A

Tall villi with deep crypts

49
Q

What happens to jejunal wall in celiac disease?

A

Villi and crypts atrophy

50
Q

What is Meckel’s diverticulum and where is it found?

A

Found in distal ileum
Remnant of embryonic vitellointestinal duct
Only found in 2% of population
May contain gastric mucosa which secretes acids
This may cause bleeding or inflammation

51
Q

What are payers patches?

A

Aggregates of lymphoid tissue within wall of small bowel

52
Q

What problems may occur to payers patches?

A

Can enlarge, particularly in lymphoma and cause intestinal luminal obstruction

53
Q

How long is the entire colon?

A

100-180cm

54
Q

How is the colon distinguished?

A

3 longitudinal bands of muscle along its length which form taenoid coli and converge at bas of appendix

55
Q

What are haustrations?

A

Sacculations caused by length of muscles being shorter than colon itself, so bunch up the colonic wall

56
Q

On radiograph, whats the difference between colon and small bowel?

A

Colon - sacculations appear as incomplete lines and occur at lumen of wall
Small bowel - mucosal folds project across entire width of bowel wall

57
Q

What is marking the ileocaecal junction and what is the function of this?

A

Marked by valve which prevents back flow of colonic contents during peristalsis

58
Q

What may happen if the caecum becomes obstructed?

A

May dilate to the point of necrosis or perforation if ileocaecal valve is competent as prevents back flow of both air and colonic contents

59
Q

Where does the caecum lie?

A

Right iliac fossa

60
Q

What is the presentation of a right sided colon tumour?

A

Mass
Change in bowel habit
Iron deficiency anaemia
Pain

61
Q

Where does the appendix arise from?

A

Postero-medial aspect of caecum

62
Q

How long is the ascending colon?

A

12-20cm

63
Q

Where does the ascending colon end?

A

At hepatic flexure

64
Q

How long is the transverse colon

A

45cm

65
Q

Where does the transverse colon end?

A

Splenic flexure

66
Q

What level is the transverse colon found?

A

Level of umbilicus but ay hang down into pelvis

67
Q

How long is the descending colon?

A

22-30cm

68
Q

How long is the sigmoid colon?

A

Average length is 37cm but may be as long as 70cm

69
Q

What are appendices apoploicae?

A

Fat-filled peritoneal tags found on outer surface of colon

70
Q

What problems may occur due to sigmoid colons length and loose attachment?

A

May twist on itself forming sigmoid volvulous

71
Q

What will as sigmoid volvulous present with?

A

Symptoms of large bowel obstruction

72
Q

What are colonic diverticulum?

A

Out pouching of bowel wall

73
Q

What is the most common location of colonic diverticulum?

A

Sigmoid colon and comply occurs where artery pierces muscular wall causing weakness

74
Q

How long is the rectum?

A

12cm

75
Q

Where does the rectum start?

A

Anterior to sacrum at S3

76
Q

Where is the most common site of colon cancer?

A

Rectum

77
Q

What are the features of ulcerative colitis?

A

Tends to occur in rectum and spread proximally throughout colon
Areas of inflammation are continuous and mucosa highly friable

78
Q

What are the features of crowns disease?

A

Patchy or focal areas of inflammation known as skip lesions

Associated ulcers are often deep and fissuring and produce a cobblestones appearance

79
Q

How long is the anal canal?

A

4cm

80
Q

What are the features of the upper anal canal?

A

Part of hind gut and lined by columnar epithelium

81
Q

What are the features of the mid anal canal?

A

Transition between endoderm of hind gut and ectoderm of proctodaeum invagination from skin
Area marked by valves of ball
Line formed by these valves is known as dentate or pectineal line

82
Q

What epithelium is found below the dentate line?

A

Stratified squamous epithelium

83
Q

What artery supplies the upper rectum?

A

Inferior mesenteric artery

84
Q

What is the innervation of the upper rectum?

A

Visceral pelvic splash nice nerves arising from sympathetic chain and S2,3 and 4

85
Q

What type of pain is felt in the upper rectum?

A

Dull and poorly located

86
Q

What is the venous drainage of the upper rectum?

A

Into portal system via inferior mesenteric vein

87
Q

What artery supplies the lower rectum?

A

Inferior rectal artery - branch of internal iliac

88
Q

What is the innervation of the lower rectum?

A

Inferior rectal nerve - somatic

89
Q

What type of pain is felt in the lower rectum?

A

Sharp and well defined

90
Q

What is the venous drainage of the lower rectum?

A

Internal iliac vein

91
Q

What is a haemorrhoid?

A

Dilatation of superior rectal vein
If confined above dentate line they are relatively painless
If extend below it will be extremely painful

92
Q

What types of tumours are found in the rectum?

A

Upper rectum - adenocarcinoma

Lower rectum - generally squamous cell carcinoma

Gastrointestinal System (15 decks)

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