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MRCEM Primary > GI tract anatomy > Flashcards

GI tract anatomy Flashcards

1
Q

How long is the oesophagus?

A

18-25cm long.

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2
Q

Where does the oesophagus originate from?

A

The pharynx at the inferior border of the cricoid cartilage.

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3
Q

At what vertebral level does the oesophagus begin at?

A

C6

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4
Q

Where does the oesophagus end?

A

At the cardiac orifice of the stomach.

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5
Q

At what vertebral level does the oesophagus end at?

A

T11

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6
Q

At what vertebral level is the oesophageal hiatus?

A

T10

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7
Q

At what costal cartilage level is the oesophageal hiatus?

A

Level of the 7th costal cartilage

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8
Q

Where is the oesophagus situated in the thorax?

A

In the superior mediastinum between the trachea and T1-T4 vertebrae.

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9
Q

What are the 3 points of constriction in the oesophagus?

A

Where pharynx joins oesophagus (behind cricoid cartilage)

Where it is crossed anteriorly by the aortic arch and left main bronchus

As the oesophageal hiatus

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10
Q

How many sphincters does the oesophagus have?

A

2

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11
Q

What type fo muscle is the upper oesophageal sphincter made of?

A

Striated muscle

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12
Q

What structures form the upper oesophageal sphincter?

A

Cricopharyngeus muscle situated at the junction between the pharynx and oesophagus.

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13
Q

Why is the upper oesophageal sphincter normally constricted?

A

To prevent entrance of air into the stomach.

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14
Q

Where is the lower oesophageal sphincter?

A

Between oesophagus and stomach (GOJ).

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15
Q

At what vertebral level is the gastro-oesophageal junction (lower oesophageal sphincter)?

A

T11

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16
Q

What is the function of the lower oesophageal sphincter?

A

Prevent reflux of gastric contents into the oesophagus.

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17
Q

Where does the thoracic oesophagus received arterial supply from?

A

Branches of thoracic aorta and inferior thyroid artery.

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18
Q

What is the venous drainage of the thoracic oesophagus?

A

Azygous veins
Inferior thyroid vein

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19
Q

What is the arterial supply to the abdominal oesophagus?

A

Left gastric branch of the coeliac trunk
Left phrenic artery

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20
Q

What is the venous drainage of the abdominal oesophagus?

A

Left gastric vein
Azygous vein

Both of above drain into portal venous system

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21
Q

What is the lymphatic drainage of the upper 1/3 of the oesophagus?

A

Deep cervical nodes

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22
Q

What is the lymphatic drainage of the middle 1/3 of the oesophagus?

A

Superior and posterior mediastinal nodes.

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23
Q

What is the lymphatic drainage of the lower 1/3 of the oesophagus?

A

Left gastric and coeliac nodes.

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24
Q

What is the innervation of the oesophagus?

A

Vagus nerve (+ cervical and thoracic sympathetic trunks)

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25
Q

What is the action of the vagus nerve on the oesophagus?

A

Supplies muscles of oesophagus, stimulating glandular contraction.

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26
Q

What are the 3 anterior relations of the thoracic oesophagus?

A

Trachea
Left recurrent laryngeal nerve
Pericardium

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27
Q

What are the 2 anterior relations of the abdominal oesophagus?

A
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28
Q

What are the 4 posterior relations of the thoracic oesophagus?

A

Thoracic vertebrae
Thoracic duct
Azygous veins
Descending aorta

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29
Q

What are the 2 posterior relations of the abdominal oesophagus?

A

Right vagus nerve
Left crus of diaphragm

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30
Q

What are the 2 right relations of the thoracic oesophagus?

A

Pleura
Terminal part of azygous vein

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31
Q

What is the right relation of the abdominal oesophagus?

A

Lesser sac of peritoneum

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32
Q

What are the 4 left relations of the thoracic oesophagus?

A

Subclavian artery
Arch of aorta
Thoracic duct
Pleura

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33
Q

What is the left relation of the abdominal oesophagus?

A

Greater sac of peritoneum.

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34
Q

What are the 4 regions of the stomach?

A

Cardia
Fundus
Body
Pylorus

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35
Q

What structure arises from the greater curvature of the stomach?

A

The greater omentum

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36
Q

What structure arises fro the lesser curvature of the stomach?

A

The lesser omentum

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37
Q

What does the angular notch of the stomach mark?

A

The junction of the body and the pylorus of the stomach.

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38
Q

Where is the angular notch of the stomach?

A

Two thirds of the way along the lesser curvature

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39
Q

Which 2 sphincters are contained within the stomach?

A

Lower oesophageal sphincter
Pyloric sphincter

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40
Q

Which 4 factors is the sphincteric effect of the lower oesophageal sphincter created by?

A

The angle at which the oesophagus enters the stomach
Compression by positive intra-abdominal pressure
Presence of mucosal folds
Locality of the right crus of the diaphragm

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41
Q

What type of muscle is the pyloric sphincter made from?

A

Smooth muscle

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42
Q

What is the function of the pyloric sphincter?

A

Controls the passage of chime into the duodenum.

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43
Q

What are the 4 layers of the stomach from external to internal?

A

Serosa
Muscle
Submucosa
Mucosa

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44
Q

What are the 5 anterior relations of the stomach?

A

Anterior abdominal wall
Left costal margin
Left pleura and lung
Diaphragm
Left lobe of the liver

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45
Q

What are the 9 posterior relations of the stomach?

A

Lesser sac
Diaphragm
Spleen
Left adrenal gland
Upper left kidney
Splenic artery
Pancreas
Transverse mesocolon
Transverse colon

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46
Q

The arterial supply of the stomach is derived from where?

A

Coeliac trunk and it’s branches

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47
Q

What are the arterial anastomoses along the lesser curvature formed by?

A

Left and right gastric arteries

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48
Q

What are the arterial anastomoses along the greater curvature formed by?

A

Left and right gastro-mental arteries.

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49
Q

Which 5 arteries provide arterial supply to the stomach?

A

Left gastric
Right gastric
Left gastro-omental
Right gastro-mental
Short gastric arteries

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50
Q

Where do the left and right gastric veins drain into?

A

Portal vein

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51
Q

Where do the short gastric veins and the left gastro-mental vein drain into?

A

Splenic vein

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52
Q

Where does the right gastro-mental vein drain into?

A

Superior mesenteric vein

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53
Q

What is the lymph drainage of the stomach?

A

Gastro-mental lymph nodes along the curvatures.

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54
Q

What is the parasympathetic innervation of the stomach?

A

Anterior and posterior vagal trunks and their branches.

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55
Q

What is the sympathetic innervation of the stomach?

A

T6-T7 spinal segments.

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56
Q

Which part of the gut wall do peptic ulcers extend through to?

A

Muscular mucosae

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57
Q

Which part of the stomach do gastric ulcers most commonly form in?

A

Lesser curvature

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58
Q

Which part of the duodenum do duodenal ulcers most commonly occur?

A

Proximal duodenum

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59
Q

What is the most frequent perforation site of peptic ulcers?

A

First part of duodenum

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60
Q

How long is the first part of the duodenum?

A

5cm

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61
Q

Which vertebral body does the first part of the duodenum lie anterior to?

A

L1

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62
Q

How is the first part of the duodenum connected to the liver?

A

Hepatoduodenal ligament

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63
Q

How long is the 2nd part of the duodenum?

A

7-10cm

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64
Q

Which vertebral bodies does the second part of the duodenum descend along?

A

L1-L3

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65
Q

The 2nd part of the duodenum curves inferiorly around which structure?

A

Head of pancreas

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66
Q

How long is the 3rd part of the duodenum?

A

6-8cm

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67
Q

Which vertebral body does the 3rd part of the duodenum cross?

A

L3

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68
Q

Which vessels does the 3rd part of the duodenum cross anteriorly over?

A

IVC and aorta

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69
Q

Where is the 3rd part of the duodenum located in relation to the pancreas?

A

Inferior to the pancreas

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70
Q

How long is the 4th part of the duodenum?

A

5cm long

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71
Q

Next to which vertebral body does the 4th part of the duodenum begin?

A

L3

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72
Q

Which vertebral level does the 4th part of the duodenum ascend to?

A

L2

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73
Q

Which part of the duodenum is the only part which is intraperitoneal?

A

1st part

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74
Q

Which parts of the duodenum are retroperitoneal?

A

All except the 1st part.

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75
Q

What is the ligament of Treitz?

A

Suspensory muscle of the duodenum

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76
Q

At what vertebral level does the ligament of Treitz sit?

A

L2

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77
Q

Which structures does the ligament of Treitz connect?

A

Connects duodenum, jejunum and duodenojejunal flexure to connective tissue surrounding SMA and coeliac artery.

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78
Q

What is the arterial supply to the duodenum?

A

Pancreaticoduodenal arteries

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79
Q

Which aspect of the duodenum is supplied by the superior pancreaticoduodenal artery?

A

Duodenum proximal to entry of bile duct (section derived from foregut)

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80
Q

Which aspect of the duodenum is supplied by the inferior pancreaticoduodenal artery?

A

Duodenum distal to entry of bile duct (section derived from midgut)

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81
Q

The superior pancreaticoduodenal artery arises from where?

A

Gastroduodenal artery

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82
Q

The inferior pancreaticoduondeal artery arises from where?

A

SMA

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83
Q

Where do the duodenal veins drain into?

A

Hepatic portal vein

84
Q

Where do the anterior lymph vessels of the duodenum drain into?

A

Pancreaticoduondeal + pyloric nodes

85
Q

Where do the posterior lymph vessels of the duodenum drain into?

A

Superior mesenteric nodes

86
Q

What is the innervation of the duodenum?

A

Vagus + sympathetic nerves via plexuses on pancreaticoduodenal arteries.

87
Q

Where does the jejunum begin?

A

At the attachment of the suspensory muscle of the duodenum (ligament of Treitz)

88
Q

Which abdominal region does the ileum normally lie under?

A

RLQ

89
Q

Which abdominal region does the jejunum normally lie under?

A

LUQ

90
Q

Where does the ileum end?

A

Ileocaecal junction

91
Q

The jejunum and ileum are suspended inside what?

A

Mesentery

92
Q

What is the arterial supply to the jejunum and ileum?

A

SMA

93
Q

At which vertebral level does the SMA arise?

A

L1

94
Q

What is the venous drainage of he jejunum and ileum?

A

Superior mesenteric vein

95
Q

What does the superior mesenteric vein unite with to form the hepatic portal vein?

A

Splenic vein

96
Q

What is the lymphatic drainage of the jejunum and ileum?

A

Mesenteric nodes

97
Q

What is the lymphatic drainage of there terminal ileum?

A

Ileocolic nodes

98
Q

Which spinal segments do the sympathetic nerves to the jejunum and ileum arise from?

A

T5-T9

99
Q

Where are the parasympathetic nerves to the jejunum and ileum derived?

A

Posterior vagal trunk

100
Q

What is a Meckel’s diverticulum?

A

A vestigial remnant of the vitellointestinal duct

101
Q

Where would a Meckel’s diverticulum be located?

A

Distal ileum (within 60-100cm of the ileocaecal valve)

102
Q

Where do mocker’s diverticulum receive their blood supply from?

A

Mesentery of the ileum

103
Q

What are the 2 most common types of ectopic mucosa found in Meckel’s diverticulum?

A

Gastric (50%)
Pancreatic (5%)

104
Q

What is the most common age in which a Meckel’s diverticulum presents?

A

2

105
Q

What is the role of the anal canal?

A

Maintenance of faecal continence and defecation.

106
Q

Where does the anal canal start?

A

Anorectal junction

107
Q

What is the innervation of the internal anal sphincter?

A

Enteric neutrons of the myenteric plexus (Auerbach’s plexus)

108
Q

Which anal sphincter is involuntary?

A

Internal

109
Q

What type of muscle is the internal anal sphincter made up of?

A

Smooth muscle

110
Q

What is the innervation of the external anal sphincter?

A

Somatic efferent neurons

111
Q

What is the pectinate (dentate) line?

A

A line that divides the upper two thirds and lower third of the anal canal

112
Q

Where is the anus located?

A

Within the anal triangle of the perineum

113
Q

What are the anterior relations of the anus in males?

A

Perineal body
Urethra
Bulb of penis

114
Q

What are the anterior relations of the anus in females?

A

Perineal body
Vagina

115
Q

What are the posterior relations of the anus?

A

Anococcygeal ligament
Coccyx
Sacrum

116
Q

What are the lateral relations of the anus?

A

Ischioanal fossa

117
Q

What is the arterial supply to the anal canal above the pectinate line?

A

Superior rectal artery (branch of IMA)

118
Q

What is the venous drainage of the anal canal above the pectinate line?

A

Superior rectal vein (drains into inferior mesenteric vein)

119
Q

What is the arterial supply to the anal canal below the pectinate line?

A

Inferior rectal artery (branch of internal pudendal artery)

120
Q

What is the venous drainage of the anal canal below the pectinate line?

A

Inferior rectal vein (drains into internal pudendal vein)

121
Q

What is the lymphatic drainage of the anal canal above the pectinate line?

A

Internal iliac nodes

122
Q

What is the lymphatic drainage of the anal canal below the pectinate line?

A

Superficial inguinal nodes

123
Q

What is the innervation of the anal canal above the pectinate line?

A

Inferior hypogastric plexus (sensitive to stretch only)

124
Q

What is the innervation of the anal canal below the pectinate line?

A

Inferior anal nerves (branches of pudendal nerve)

**Sensitive to pain, touch, pressure + temperature

125
Q

What spinal segments are responsible for the anal reflex?

A

S2-S4

126
Q

Which nerve carries the anal reflex arc?

A

Pudendal nerve

127
Q

How long is the rectum?

A

12-15cm

128
Q

Where does the rectum start?

A

Rectosigmoid junction

129
Q

At what vertebral level does the rectum start?

A

L3 (where the mesocolon ends)

130
Q

At what vertebral level does the mesocolon end?

A

L3

131
Q

What are the 3 flexures of the rectum?

A

Sacral
Anorectal
3 x lateral (superior, intermediate, inferior)

132
Q

Which part of the rectum are faeces stored in?

A

Rectal ampulla (distal end of rectum)

133
Q

Which flexure of the rectum is responsible for producing the angle of the rectum that maintains faecal continence?

A

Anorectal flexure

134
Q

The tone of which muscles forms the anorectal flexure?

A

Puborectalis muscle

135
Q

Relaxation of which muscle allows the anorectal angle to be reduced + defecation to occur?

A

Puborectalis muscle

136
Q

Where does the rectum end?

A

Anorectal junction

137
Q

Which muscle sling is present at the level where the rectum ends?

A

Puborectalis sling

138
Q

What are the anterior relations of the rectum in men?

A

Sigmoid colon
Ileum
Rectovesical pouch
Bladder
Prostate

139
Q

What are the anterior relations of the rectum in women?

A

Sigmoid colon
Ileum
Rectouterine pouch
Vagina
Cervix

140
Q

What are the posterior relations of the rectum?

A

Sacral plexus
Sacrum
Coccyx
Piriformis
Coccygeus
Levator ani

141
Q

Which 3 arteries provide arterial supply to the rectum?

A

Superior, middle and inferior rectal arteries

142
Q

The superior rectal artery is a branch of what?

A

IMA

143
Q

The middle rectal artery is a branch of what?

A

Internal iliac artery

144
Q

The inferior rectal artery is a branch of what?

A

Pudendal artery

145
Q

What is the venous drainage of the rectum?

A

Superior, middle and inferior rectal veins

146
Q

Where do the superior rectal veins drain into?

A

Portal venous system

147
Q

Where do the middle and inferior rectal arteries drain into?

A

Systemic venous system

148
Q

What can the portosystemic anastomosis in the anal canal cause?

A

Haemorrhoids

149
Q

Where does lymph from the upper third of the rectum drain to?

A

Pararectal nodes > inferior mesenteric nodes

150
Q

Where does lymph from the lower third of the rectum drain into?

A

Internal iliac lymph nodes

151
Q

What is the sympathetic innervation of the rectum?

A

Lumbar splanchnic nerves

AND

superior and inferior mesenteric plexuses

152
Q

What is the parasympathetic innervation of the rectum?

A

Pelvic splanchnic nerves

AND

inferior hypogastric plexuses

153
Q

What is the sensory innervation of the rectum?

A

Pelvic splanchnic nerves

AND

inferior hypogastric plexus

154
Q

Which structure plays an important role in limiting the spread of carcinoma to the rectum?

A

Rectovesical fascia

155
Q

What is the rectovesical fascia?

A

A membranous partition situated at the lowest part of the rectovesical pouch.

156
Q

In males, what does the rectovesical pouch separate?

A

Rectum from prostate + bladder.

157
Q

In females, what does the rectovesical pouch separate?

A

Rectum from vagina.

158
Q

Is the ascending colon peritoneal or retroperitoneal?

A

Retroperitoneal

159
Q

Is the transverse colon intraperitoneal or retroperitoneal?

A

Intraperitoneal

160
Q

What is the least fixed part of the colon?

A

Transverse colon

161
Q

Is the descending colon intraperitoneal or retroperitoneal?

A

Retroperitoneal

162
Q

Is the sigmoid colon intraperitoneal or retroperitoneal?

A

Intraperitoneal

163
Q

What vertebral level does the sigmoid colon finish at?

A

S3

164
Q

What are the 3 anterior relations of the ascending colon?

A

Anterior abdominal wall
Small intestine
Greater omentum

165
Q

What are the 5 posterior relations of the ascending colon?

A

Quadratus lumborum
Iliacus
Right kidney
Iliohypogastric nerve
Ilioinguinal nerve

166
Q

What are the 2 anterior relations of the transverse colon?

A

Anterior abdominal wall
Greater omentum

167
Q

What are the 4 posterior relations of the transverse colon?

A

Duodenum
Jejunum
Ileum
Head of pancreas

168
Q

What are the 3 anterior relations of the descending colon?

A

Anterior abdominal wall
Small intestine
Greater omentum

169
Q

What are the 5 posterior relations of the descending colon?

A

Quadratus lumborum
Iliacus
Left kidney
Iliohypogastric nerve
Ilioingunal nerve

170
Q

What are the 3 anterior relations of the sigmoid colon?

A

Urinary bladder
Uterus (females)
Upper vagina (females)

171
Q

What are the 2 posterior relations of the sigmoid colon?

A

Rectum
Sacrum

172
Q

Where does the superior mesenteric artery arise?

A

L1 (1cm below coeliac trunk)

173
Q

Where does the inferior mesenteric artery arise?

A

L3

174
Q

Which parts of the colon are supplied by the SMA?

A

Ascending colon
2/3rds transverse colon

175
Q

Which parts of the colon are supplied by the IMA?

A

1/3rd transverse colon
Descending colon
Sigmoid colon

176
Q

What is the arterial supply of the ascending colon?

A

SMA:

Ileocolic artery
Right colic artery

177
Q

What is the arterial supply to the transverse colon?

A

SMA:
Right colic artery
Middle colic artery
IMA:
Left colic artery

178
Q

What is the arterial supply of the descending colon?

A

Left colic artery (IMA)

179
Q

What is the arterial supply of the sigmoid colon?

A

Sigmoid arteries (IMA)

180
Q

What is the venous drainage of the ascending colon?

A

Ileocolic and right colic veins (drain to SM vein)

181
Q

What is the venous drainage of the transverse colon?

A

Superior mesenteric vein

182
Q

What is the venous drainage of the descending colon?

A

Left colic vein (drains to IM vein)

183
Q

What is the venous drainage of the sigmoid colon?

A

Sigmoid veins (drain to IM vein)

184
Q

Where do the superior and inferior mesenteric veins drain into?

A

Hepatic portal vein

185
Q

What is the lymphatic drainage of the ascending colon and proximal 2/3 of the transverse colon?

A

Colic nodes
Superior mesenteric nodes

186
Q

What is the lymphatic drainage of the distal 1/3 of the transverse colon, descending colon and sigmoid colon?

A

Colic nodes
Inferior mesenteric nodes

187
Q

Where do the colic, superior mesenteric and inferior mesenteric nodes drain to?

A

Cisterna chyli > thoracic duct

188
Q

Which structures are innervated by the superior mesenteric plexus?

A

Ascending colon
Proximal 2/3 transverse colon

189
Q

Which structures are innervated by the inferior mesenteric plexus?

A

Distal 1/3 transverse colon
Descending colon
Sigmoid colon

190
Q

Where is the most common site of diverticulitis?

A

Sigmoid colon

191
Q

What does the caecum do?

A

Acts as a reservoir for chyme received from the ileum.

192
Q

Is the caecum intraperitoneal or retroperitoneal?

A

Intraperitoneal

193
Q

What part of the caecum is the appendix attached to?

A

Posteromedial end of the caecum.

194
Q

What are the 2 most common locations for the end of the appendix to be found?

A

Retrocaecal (ascending retrocaecal = 64%)
Subcaecal (32%)

195
Q

What is the arterial supply to the caecum?

A

Anterior and posterior caecal arteries

196
Q

What is the venous drainage of the caecum?

A

Ileocolic vein

197
Q

What is the arterial supply to the appendix?

A

Appendicular artery

198
Q

What is the venous drainage from the appendix?

A

Appendicular vein

199
Q

Where does lymph from the caecum and appendix drain to?

A

Nodes in mesoappendix and ileocolic nodes.

200
Q

Where do the ileocolic nodes lie?

A

Along the ileocolic artery

201
Q

What is the innervation of the caecum and appendix?

A

Derived from sympathetic and parasympathetic nerves of the superior mesenteric plexus

202
Q

Which part of the spinal cord do afferent fibres from the appendix travel to?

A

T10 segment of spinal cord

203
Q

The sympathetic fibres supplying the caecum and appendix originate from where?

A

Lower thoracic part of the spinal cord

204
Q

The parasympathetic fibres supplying the caecum and appendix originate from where?

A

Vagus nerve

205
Q

Where is does McBurney’s point lie?

A

1/3rd of the distance from the ASIS to the umbilicus.

206
Q

What does McBurney’s point correspond to?

A

The most common position of the attachment the base of the appendix to the caecum.

207
Q
A

MRCEM Primary (39 decks)

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