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78 Cards in this Set
- Front
- Back
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What is the GIT?
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stomach and intestines
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What is the location of the oesophagus and GIT?
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oesophagus - neck, thorax, abdomen
GIT - abdominopelvic cavity (except for anal canal, which is in perineum) |
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What are the divisions of the primitive gut, what do they supply and where are they located?
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foregut - (supplied by coeliac trunk) extends as far as the entry of bile duct into the duodenum
midgut - (supplied by SMA) continues to 2/3 transverse colon hindgut - (supplied by IMA) distal 1/3 transverse colon to upper ectodermal part of anal canal (above pectinate line) |
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Where is the pectinate line?
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halfway along anal canal
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What structures are associated with the foregut and what branches do they receive?
And the midgut? |
liver, most of pancreas, spleen (receive branches of coeliac trunk)
lower part of pancreas (branches of SMA) |
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What is the neurovascular supply to the MIDGUT (arterial, venous, lymphatic, autonomic, pain referral)?
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arterial - SMA
venous - SMV lymph - superior mesenteric nodes autonomic - sympathetic fibres to superior mesenteric ganglion and its post-ganglionic fibres |
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What is the neurovascular supply to the HINDGUT (arterial, venous, lymphatic, autonomic, pain referral)?
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((same as midgut but with inferior mesenteric instead of superior mesenteric))
arterial - IMA venous - IMV lymph - inferior mesenteric nodes autonomic - sympathetic fibres (lumbar splanchnic nerves) to inferior mesenteric ganglion and its post-ganglionic fibres |
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What is the neurovascular supply to the FOREGUT (arterial, venous, lymphatic, autonomic, pain referral)?
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((slightly different pattern to mid/hindgut))
arterial - coeliac trunk venous - splenic vein lymph - coeliac nodes autonomic - sympathetic fibres (thoracic splanchnic nerves) to coeliac ganglion and its post-ganglionic fibres |
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What are the vertebral levels of coeliac trunk, SMA and IMA? Which directions do the SMA and IMA generally pass toward?
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coeliac trunk - T12
SMA - L1 (passes towards the right) IMA - L3 (passes towards the left) |
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What are the three branches of the coeliac trunk and what are their courses?
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1. left gastric (moves up (to supply bit of oesophagus) then does U-turn at stomach)
2. splenic (long branch, passes left behind stomach to supply spleen) 3. common hepatic |
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What are the six branches of the superior mesenteric artery, what are their courses and what do they supply?
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(supplies midgut)
1. inferior pancreaticoduodenal 2. jejunal brs (up to 20) 3. ileal brs (up to 20) 4. iliocolic (goes down to were ilieum and colon are starting) 5. right colic 6. middle colic |
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What are the branches of the IMA, what are their courses and what do they supply?
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(supplies hindgut)
1. left colic 2. sigmoidal (2-3 brs) 3. superior rectal (the continuation of the IMA after the pelvic brim) |
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What artery anastomoses the arteries that supply the colon, located on the inside of the colon?
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marginal artery
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Relative to the pancreas, where do the coelic trunk and SMA come off the abdominal aorta?
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coeliac trunk - comes off above pancreas
SMA - comes off behind pancreas |
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What is the neck of Deborah Bryce's venous 'greyhound dog'? What do the ears and snout of the dog represent?
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portal vein (connects at junction of SMV and splenic vein)
left branch of portal vein- ears of dog right branch of portal vein - snout of dog |
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Where does the portal vein pass?
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forms behind neck of pancreas (from union of SMV and SV), ascends posterior to 1st part of duodenum, then passes through lesser omentum to liver
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Why might venous blood from the portal vein rely on anastomosed pathways rather than its regular course? Where are the sites of the 4 anastomoses (and their pathologies in venous congestion)?
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hepatic congestion
sites of anastomoses: 1. distal oesophagus (haematemesis, upper GIT bleed) 2. walls of anal canal (haemorrhoids) 3. umbilicus/abdo wall (caput medusae) 4. retroperitoneal (silent) |
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What parts of the GIT does the vagus nerve supply? What is the sympathetic supply to these GIT parts?
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parasympathetic to foregut and midgut
sympathetic supply is thoracic splanchnic |
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What embryonic structure communicates with the future ileum and the yolk sac?
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vitelline duct
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What is the rotation of the stomach in embryo? What is the axis its rotation?
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270 degrees counterclockwise
axis of rotation = superior mesenteric artery |
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When does the stomach herniate from the anterior abdominal wall?
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between weeks 6-10 of development
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What does the greater omentum hang over?
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hangs down like an apron over anterior jejunum and ileum
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What structures suspend the jejunoileum, transverse colon and sigmoid colon?
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jejunoileum - mesentery
transverse colon - transverse mesocolon sigmoid colon - sigmoid mesocolon |
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What is the greater omentum developed from?
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dorsal mesentery of foregut
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What flap-like structure is adherent to the transverse colon and transverse mesocolon?
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greater omentum
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T/F... the peritoneal cavity contains viscera
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false. it contains peritoneal fluid
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T/F... the peritoneum is highly permeable
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true
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Where is the peritoneal cavity open in males and females and what risk does it pose?
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closed in males, open in females at the ends of the uterine tubes (risk of peritonitis)
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What is the name of the outpouch of the peritoneal cavity behind the stomach?
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lesser sac (omental bursa)
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What divides the two parts of the greater sac and what are their respective names?
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divided by transverse colon
supracolic and infracolic compartments of the greater sac |
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What structures are retroperitoneal?
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pancreas, duodenum, aorta, IVC, kidneys
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What structures are extraperitoneal?
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bladder, extraperitoneal fat
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What structures are intraperitoneal?
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liver, stomach, transverse colon, jejunum, ileum
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How long is the oesophagus?
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25cm
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What muscle forms the lowest part of the inferior constrictor muscle of the pharynx? When is it contracted? What is it attached to?
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cricopharyngeus, it is tonically contracted and attached to back of cricoid
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What is the function of the cricopharyngeus?
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tonically contracted, prevents air from entering oesophagus by keeping it closed. It relaxes when swallowing, vomiting or burping
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What is known as the upper oesophageal sphincter?
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cricopharyngeus muscle
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What is the starting point of the oesophagus?
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starting point of trachea, lower border of cricoid cartilage. C6
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The mucuous membrane of the oesophagus is made out of what cells? What does it become in the stomach?
Why is mucous useful? |
stratified squamous epithelium
stomach has columnar epithelium mucus assists passage of bolus of food |
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What and where is the Z-line?
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squamo-columnar junction: where the oesophagus' stratified squamous epithelium immediately transitions into the stomach's columnar epithelium.
its located at the oesophageal hiatus |
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What are the muscle types of the oesophagus?
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upper 1/3rd skeletal muscle (like pharynx)
middle 1/3rd mixed smooth and skeletal lower 1/3rd smooth muscle (like stomach) outer longitudinal and inner circular layer of muscle |
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When is the lower oesophageal sphincter contracted and why?
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Tonically contractred to prevent gastro-oesophageal reflux (GORD)
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T/F.. the descending thoracic aorta lies posterior to the oesophagus
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true - only in the lower oesophagus though
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When does the thoracic duct pass behind the oesophagus? What direction does it pass behind it?
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T5/6. It starts on the right hand side and ascends across to the left side of the oesophagus
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What and where are the four constriction points of the oesophagus?
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1. upper oesophageal sphincter (C6)
2. arch of aorta (on left side of oesophagus, T4) 3. left principal bronchus (T4/5) 4. oesophageal hiatus of diaphragm (T10) |
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What is the relatively transverse shape of a full stomach?
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steer-horn shape
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What are the three anterior relations of the stomach?
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liver, diaphragm and anterior abdominal wall
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What are the two curvatures of the stomach?
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1. lesser curvature (on right side, between oesophagus and duodenum)
2. greater curvature (on left side) |
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What is the notch between oesophagus and fundus?
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cardiac notch
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Where is the angular notch of stomach?
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proximal end of lesser curvature
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What are the four parts of the stomach?
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1. cardia (end of oesophagus)
2. fundus (imagine drawing a horizontal line across stomach from cardiac notch - fundus is above that) 3. body (draw line from angular notch to greater curvature. it is the space between that and fundus) 4. pyloric part (remainder of stomach) - contains pyloric antrum --> pyloric canal --> pyloric orifice (the opening into duodenum) |
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What level is the transpyloric plane?
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L1
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What is the name of the folds of the mucus membrane of an empty stomach?
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rugae
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What are the three layers of muscle of stomach wall?
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outermost--> deepest
1. outer longitudinal layer 2. middle circular layer 3. inner oblique layer |
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What layer of muscle forms the pyloric sphincter?
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middle smooth layer
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What does pyloris mean in Greek?
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gate keeper (ie. pyloric sphincter controls flow of crap into the duodenum)
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What pathology of pyloric sphincter leads to projective vomiting in children?
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pyloric stenosis, as food can't get through
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Where does the lesser omentum pass from stomach and what are its two parts?
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passes up to liver from lesser curvature.
Parts: 1. hepatogastric ligament 2. hepatoduodenal ligament (from duodenum) |
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What window lies inside the hepatoduodenal ligament of lesser omentum?
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portal triad
window shows portal vein behind, with bile duct and common hepatic artery in front |
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What are the three parts of the greater omentum?
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1. gastrophrenic ligament (stomach to diaphragm)
2. gastrolienal ligament (stomach to spleen) 3. gastrocolic ligmament (AKA greater omentum) |
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Why is the greater omentum known as the 'policeman' of the abdomen?
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prevents generalised peritonitis as it can move to inflamed viscera, adhere to it and seal it off
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What lies posteriorly to the stomach (stomach bed)?
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from bottom to top: transverse colon, transverse mesocolon, pancreas, splenic artery, superior part of left kidney, left suprarenal gland, diaphragm + spleen
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Where does the lesser sac lie relative to stomach and what is its function?
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lies behind stomach, allowing it to slip 'n slide.
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What structure helps finding the omental (epiploic) foramen?
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gall bladder (as it is attached to the free end of the lesser omentum, behind which lies the epiploic foramen)
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What is the epiploic foramen?
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the opening into the lesser sac
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If you stuck your finger into the epiploic foramen, what would be in front and behind your finger?
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behind - IVC
in front - portal vein, bile duct, hepatic artery |
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What part of liver projects down into the omental bursa (lesser sac)?
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caudate lobe of liver
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What is the duodenum and what does it mean in Latin?
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It's the first part of the small intestine. It means twelve in Latin, as it is twelve finger breadths long (25cm, same length as oesophagus).
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How many parts of the duodenum are there and what are they called?
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four parts
1st - superior part 2nd - descending 3rd - inferior part 4th - ascending |
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What are the major blood vessels lying behind 3rd part of duodenum? and in front?
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behind - IVC, abdominal aorta
in front - superior mesenteric vessels |
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What is another name for the suspensory ligament of the duodenum? What is its function?
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ligament of Treitz (attaches to 4th part of duodenum). Helps keep passage of food appropriately oriented from duodenum to jejunum as the angle is quite sharp
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What are the spinal levels of the duodenum?
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1st part - L1
3rd part - L3 4th part - L2 |
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On radipgraph, what is the shape of the duodenal cap? What is the texture of its wall?
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triangle shaped. it is smooth walled as opposed to the rest of the duodenum, which is corrugated
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What is another name for the circular folds of the duodenum?
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plicae circulares or valves of Kerckring
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What are the two elevations inside the duodenum?
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minor and major duodenal papillae
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What ducts does the major duodenal papilla receive? What part of the duodenum does it lie?
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bile and pancreatic ducts
it lies in the 2nd part of duodenum |
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What is the name of the gastric contents passing into the duodenum?
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chyme
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What does rugae mean in Latin and what happens to them when the stomach fills?
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means wrinkles. They flatten as the stomach fills
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