Wet Room 2 Flashcards by Andrew Hay

Give a brief description of the oesophagus

Muscular tube -25cm long and extends from the pharynx to the stomach.
The abdominal part of the oesophagus is only about 1.25cm long

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What are the 3 constrictions of the oesophagus?

Cervical
Thoracic
Diaphragmatic

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What is the vertebral level of the oesophageal opening (hiatus) in the diaphragm?

T10

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List the structures that traverse the oesophageal opening

Oesophagus
Vagal trunks
Oesophageal branches of the left gastric vessels
Lymphatic vessels

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what is the blood supply of the oesophagus?

Branches of the left gastric artery

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What is the venous drainage of the oesophagus?

Left gastric vein

This drains into the portal venous system

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What is the lymphatic drainage of the oesophagus?

Left gastric lymph nodes

These drain into the celiac lymph nodes

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Where is the portosystemic anastomosis in the oesophagus and what is its clinical significance?

The lower end of the oesophagus is one of the important sites for portosystemic anastmoses.

In portal hypertension, the anastomoses open and forms venous dilatations called oesophageal varices.

Their rupture causes severe and dangerous haematemesis

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What is the stomach?

The stomach is a muscular bag forming the widest and most distensible part of the digestive tube.

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What are the two orifices of the stomach?

Cardial Orifice

Pyloric Orifice

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What are the two curvatures of the stomach?

The Greater Curvature

The Lesser Curvature

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What are the two surfaces of the stomach?

Posterior

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What is the pyloric sphincter?

Thickening of the circular layer of smooth muscle

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What is the function of the pyloric sphincter?

Controls discharge of the stomach contents through the pyloric orifice

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The pyloric sphincter is formed from the thickening of which layer of gut tube?

Circular muscle layer of the muscularis externa

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Some children are born with which congenital disease of the pyloric sphincter?

Congenital pyloric stenosis

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The lesser omentum extends between which two points?

lesser curvature of the stomach to the liver

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The greater omentum extends between which two structures?

Greater curvature of the stomach to the transverse colon.

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What are the gastric folds/ rugae formed from and what portions of the stomach are they most apparent?

Gastric mucosa

Pyloric Part
Greater Curvature

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The stomach lies of several structures in the abdominal cavity.
These structures form the stomach bed (posterior wall of the omental bursa)
List them

Left dome of the diaphragm
Left kidney
Spleen
Suprarenal gland
Splenic artery
Colon 
Pancreas

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What are the 3 main branches of the celiac trunk?

Left gastric artery
Common Hepatic artery
Splenic artery

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What is the venous drainage of the stomach?

Venous drainage is, of course, via the portal system

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The 4 primary lymph node groups of the stomach drain into what group of nodes?

Celiac Lymph nodes

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What area of the stomach are gastric cancers most likely to occur?

The greater curvature.

On this account the lymphatic drainage of stomach assumes importance.

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The vagus nerve is key in controlling gastric motility. What is the effect of increased vagal stimulation on: a) The pylorus? b) Gastric secretion?

a) Starts/ Increases contraction | b) Increased

The arrangement of vagal branches to the stomach allows for highly selective vagotomy to be used to treat over- active gastric acid secretion. Which areas are usually denervated and which areas are preserved?

The fundus and body are denervated | Supply to the antrum is preserved so that essential gastric motility is preserved.

Where does the small intestine extend from?

Extends from the pylorus of the stomach to the ileocecal junction

What are the 3 parts of the small intestine?

Duodenum Jejunum Ileum

Which part of the small intestine receives the opening of the bile and pancreatic duct?

Duodenum

Where is the foregut/midgut boundary in the small intestine?

Entry of the bile duct into the duodenum

How are the different parts of the small intestine peritonised?

``` Duodenum = Reteroperitoneum Jejunum = Intraperitoneum Ileum = Intraperitoneum ```

Which part of the small intestine is the shortest, widest and most fixed part?

Duodenum

How does the colour of the jejunum and ileum differ?

``` Jejunum = deeper red Ileum = paler pink ```

How does the wall of the jejunum and ileum differ?

``` Jejunum = Thick + Heavy Ileum = Thi and light ```

How does the vascularity of the jejunum and ileum differ?

``` Jejunum = Greater Ileum = Less ```

How does the vasa recta differ for the jejunum and the ileum?

``` Jejunum = long Ileum = Short ```

How do the arcades of the jejunum and ileum differ?

``` Jejunum = a few large loops Ileum = many short loops ```

how does the fat in the mesentery differ between the jejunum and ileum?

``` Jejunum = less Ileum = many ```

How do the circular folds differ in the jejunum and the ileum?

``` Jejunum = large, tall and closely packed Ileum = Smaller, absent in terminal part ```

Where is the transition from jejunum to ileum?

There is no step-transition between jejunum and ileum, rather the morphology gradually alters, but either end is quite different

Which part of the autonomic nervous system (sympathetic or parasympathetic) do stimulations reduce the secretion and motility of the intestine and also acts as a vasoconstrictor

Sympathetic

What features can distinguish the large intestine from the small intestine?

Teniae coli Haustra Omental appendices

How are the parts of the large intestine peritonised?

``` Caecum = Intraperitoneum Ascending colon = Reteroperitoneum Transverse colon = Intraperitoneum Descending colon = Reteroperitoneum Sigmoid Colon = Intraperitoneum ```

In which abdominal region is the caecum and appendix located?

Right inguinal

What is McBurney's point?

Point of maximum tenderness in appendicitis

What is the most common position for the appendix?

Rectocecal

What is the arterial supply, venous drainage and peritonisation of the Superior 1/3 or the rectum?

Arterial supply = Superior rectal Venous drainage = Superior vein (portal system) Peritonisation = Intraperitoneum

What is the arterial supply, venous drainage and peritonisation of the middle 1/3 of the rectum?

Arterial supply = Middle rectum Venous drainage = Middle vein (systemic circulation) Peritonisation = Retroperitoneum

What is the arterial supply, venous drainage and peritonisation of the Inferior 1/3 of the rectum?

Arterial supply = Inferior rectal Venous drainage = Inferior vein (systemic circulation) Peritonisation = None

What is the role of the pelvic floor in maintaining faecal continence?

Increases intra-abdominal pressure

What other structures are involved in faecal continence other than the pelvic floor?

External and internal sphincter

The hepatoduodenal and hepatogastric ligaments are parts of which omentum?

Lesser omentum

What structure in the free edge of the falciform ligament is a remnant of an embryonic blood vessel? What is the name of this vessel in the embryo?

The round ligament of the liver Left umbilical vein

How many layers of peritoneum are present in the greater momentum?

The greater momentum is often called the abdominal policeman. What functions of this structure lead to this term being used?

Role in fighting intra-abdominal infection

What are the paracolic gutters?

Spaces between ascending and descending colon and abdominal wall They are found lateral to the large intestine. Infections can gather in these spaces

List 3 abdominal viscera which lie in the free edge of a double layer of peritoneum described as the mesentery

Appendix Colon Small intestine

What muscle type's form the muscularis externa?

Circular and longditudinal

What type of muscle is the muscularis mucosae?

Smooth

What are the large folds present in the wall of the stomach?

Ruggae

What secretory cells are present in the gastric pits?

surface mucous cells

What kind of epithelium is found in the oesophagus?

Stratified squamous

What kind of epithelium is found in the small intestine?

Simple columnar

Where, along the gut tube, do glands extend down beyond the muscularis mucosae?

Duodenum and Oesophagus

What is the predominant cell present in the surface epithelium?

Goblet cells

What is the epithelium in the rectum?

stratified squamous

List the structures present in the transpyloric plane

``` Pylorus of the stomach Neck of pancreas Fundus of gall bladder Spleen Hilum of R+L Kidney ```

In a barium meal which organ is examined?

Stomach

In a barium meal follow through which organ is being examined?

Small intestine

In a barium enema which organ is being examined?

Colon

What are the 4 groups of lymph nodes that drain the stomach?

Right and left gastric Right and left gastroomental Suprepyloric and subpyloric Splenic