Digestive system: foregut and midgut Flashcards

1
Q

How is blood pumped into the hepatic portal system

A

Blood is pumped from the heart into arteries which go into arterioles then capillaries that line the lamina propria of the small and large intestine.

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2
Q

In the hepatic portal system after the blood is in the lamina propria what happens

A

the venules drain the capillaries which give rise to the veins of the hepatic portal system , these become venules again and exchange substances to the second capillaries (hepatic sinusoids) which give rise to the terminal hepatic venules which dump into hepatic veins

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3
Q

Where does the hepatic portal vein dump

A

into the parenchyma of the liver

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4
Q

What does the portal vein collect

A

GI visceral blood (blood from gut tube, foregut, midgut, hindgut, accessory digestive glands and the spleen)

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5
Q

What do the left and right gastric veins drain

A

drain from the lesser curvature of the stomach directly into the portal vein.

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6
Q

What do the gastroepiploic veins drain to

A

the portal vein and splenic vein

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7
Q

What does the splenic vein drain blood from

A

the spleen

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8
Q

What veins go from the pancreas into the splenic vein

A

pancreatic veins

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9
Q

What does the hepatic portal system not have

A

Valves - so blood flow can be in any direction depending on pressure gradient

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10
Q

What are the porto-caval anastomoses

A

tissue areas in the GI tract where blood drains into hepatic portal system and caval veins

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11
Q

Name the porto-caval anastomoses

A

oesophagus, rectum and superficial abdomen

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12
Q

What does the inferior vena cava split into

A

the common iliac vein and then gives rise to an internal and external iliac vein

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13
Q

How does the left gastric vein drain blood from the distal oesophagus

A

drains from oesophagus to the hepatic portal vein to the liver through the sinusoids of portal veins in to the vena cava, back to the heart

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14
Q

What is the caval drainage of the distal oesophagus

A

through esophageal veins that go directly to the azygous veins then to the superior vena cava

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15
Q

What happens if there is a congestion into the portal vein

A

blood starts flowing backwards into its tributaries (can do this because there are no valves) back into the distal oesophagus. The blood then gets pushed into the oesophageal veins that go into the azygous veins

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16
Q

What is congestion in the portal vein called

A

portal hypertension

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17
Q

What does the backflow of blood from the portal vein cause

A

esophageal varices where they swell (due to increased blood flow) and can become varicose veins and burst

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18
Q

What is the portal drainage of the rectum

A

the superior rectal vein

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19
Q

What does the superior rectal vein drain into

A

the inferior mesenteric vein which goes into the splenic vein then into the hepatic portal vein into the liver

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20
Q

What is the caval drainage of the rectum

A

drains into the middle and inferior rectal veins

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21
Q

What do the middle and inferior rectal veins drain into

A

the internal iliac vein which goes into the common iliac vein into the inferior vena cava back to the heart

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22
Q

What does congestion in the portal vein cause to the rectum

A

causes blood to be directed into the inferior rectal veins which swell and cause internal haemorrhoids

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23
Q

What is the caval drainage for the abdominal wall - superficial fascia

A

superfifical epigastric veins

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24
Q

What do the superficial epigastric veins drain into

A

the femoral vein which becomes the external iliac and then goes into the common iliac then the inferior vena cava back to the heart

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25
Q

What does the portal drainage (Camper’s fascia) of the abdominal wall involve

A

periumbilical vein

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26
Q

Where do the periumbilical veins run

A

They follow the round ligament in through the umbilicus and down the falciform ligament to the liver then into the portal vein

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27
Q

What does congestion in the portal vein of the abdominal wall cause

A

vein causes blood to dilate the periumbilical veins causing caput medusa

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28
Q

Where does the superior mesenteric artery arise

A

from the abdominal aorta in the upper boarder of L1

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29
Q

What branches does the superior mesenteric artery give off

A

a series of jejunal and ileal branches which give rise to a series of short arteries - the vasa recta

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30
Q

What do the vasa recta form

A

arterial arcades

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31
Q

What runs parallel to the small intestine

A

a channel formed of various jejunal/ileal branches which anastomose to form the arterial arcases

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32
Q

What are the vasa recta

A

the short, straight channels in the arterial arcades

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33
Q

Name the colic arteries that come off the superior mesenteric artery

A

middle colic artery, right colic artery and ileocolic artery

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34
Q

Where do the colic arteries run

A

towards the colon and cecum in arterial arcades

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35
Q

What is the marginal artery

A

the arteries that come off the arterial arcades to supply the colon

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36
Q

What does the ileocolic artery supply

A

the proximal portion of the colon, the cecum

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37
Q

What artery does the ileocolic artery give rise to

A

the appendicular artery

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38
Q

Where does the appendicular artery travel

A

this goes posterior to the ileum and supplies the appendix

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39
Q

Where does the inferior mesenteric artery come off

A

from abdominal aorta at L3

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40
Q

What does the inferior mesenteric artery branch off into

A

the left colic artery

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41
Q

Where does the left colic artery run

A

heads retroperitoneal towards the descending colon

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42
Q

At the descending colon, what does the left colic artery branch into

A

the ascending and descending branches of the left colic artery

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43
Q

What do the ascending and descending branches of the left colic artery run into

A

the marginal artery which continues all the way along the large intestine

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44
Q

What does the marginal artery recieve as it runs parallel to the sigmoid colon

A

sigmoidal arteries which come off the mesenteric artery

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45
Q

What is the final branch that comes off the inferior mesenteric artery

A

The superior rectal artery

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46
Q

What does the superior rectal artery supply

A

the upper portions of the rectum

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47
Q

What supplies the lower portions of the rectum

A

internal iliac arter

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48
Q

What surround each of the main vessels e.g., coeliac trunk

A

aortic plexuses (contain sympathetic and parasympathetic fibres)

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49
Q

What plexus surrounds the coealiac trunk

A

the coeliac plxus

50
Q

What plexus surrounds the superior mesenteric artery

A

superior mesenteric plexus

51
Q

What plexus surrounds the inferior mesenteric plexus

A

the inferior mesenteric plexus

52
Q

What does the superior hypogastric plexus surround

A

the bifurication of the aorta

53
Q

What surrounds each internal iliac artery

A

the 2 inferior hypogastric plexus

54
Q

How are the inferior and superior hypogastric plexuses in connection with each other

A

through the right and left hypogastric nerve

55
Q

What runs along the spinal cord

A

the sympathetic chain

56
Q

What does the sympathetic chain contain

A

sympathetic fibres that have left the spinal cord from the thoracic and lumbar regions

57
Q

Where can a sympathetic fibre associated with the abdomen leave at

A

the 5th, 6th, 7th, 8th, 9th, 10th, 11th and 13th thoracic spinal cord segment. Will also leave from the 1st, 2nd and 3rd lumbar segments

58
Q

What are pre-synaptic sympathetic fibres

A

the sympathetic nerve that passes towards the sympathetic chain from the spinal cord

59
Q

How does a nerve signal transmit to the heart/lungs

A

A sympathetic nerve that passes towards the thoracic viscera then you form a synapse at the 1st, 2nd and 3rd lumbar segments with a post-synaptic sympathetic fibre where they will then pass to the heart or the lungs

60
Q

Name the 3 pre-aortic ganglia

A

the coeliac ganglia, superior mesenteric ganglia and the inferior mesenteric ganglia.

61
Q

What does an abdominal sympathetic nerve’s pre-synaptic fibre do

A

pass straight through the sympathetic chain without synapsing to synapse at pre-aortic ganglion

62
Q

What do sympathetic fibres from T5-T9 do

A

pass towards the coeliac ganglia (pass through sympathetic chain without synapsing) - this is a pre-synaptic fibre

63
Q

What do fibres from T5-T9 run in

A

the greater splanchnic nerve

64
Q

What does the pre-synaptic ganglia do when it reached the coeliac ganglia

A

synapse with a post-synaptic fibre

65
Q

Once the pre-synaptic fibre has synapsed at the coeliac plexus what does it do

A

passes within the coeliac plexus towards the branches of the coeliac trunk where it goes to the foregut

66
Q

What do the nerves from the coeliac plexus run alongside

A

the arteries that supply the foregut as periarterial branches and the liver sympathetic input to the foregut

67
Q

What does T10 and T11 give rise to

A

pre-synaptic fibres that goes towards the superior mesenteric ganglia as the lesser splanchnic nerve

68
Q

What do the T10-T11 pre-synaptic fibres do

A

forms a synapse with a post-synaptic fibre that goes towards the superior mesenteric plexus and runs alongside the branches of the superior mesenteric artery to supply sympathetic input to the midgut

69
Q

What nerve reinforces the input from the lesser splanchnic nerve

A

the least splanchnic nerve from T12 - follows same route as lesser splanchnic nerve

70
Q

Where does the inferior mesenteric ganglia receive input from

A

1st, 2nd and 3rd lumbar segments - lumbar splanchnic nerves

71
Q

Where do the lumbar splanchnic nerves synpase

A

through the inferior mesenteric plexus alongside the inferior mesenteric artery through the hind gut

72
Q

What provides the parasympathetic input

A

vagus nerve and pelvic splanchnic nerves

73
Q

Where does the vagus nerve come from and where does it run

A

the medulla oblongata of the brain stem and this enters the abdomen via the oesophageal hiatus that runs over the vagus trunks and over the surface of the stomach

74
Q

Where does the posterior trunk of the vagus trunk come from

A

the coeliac plexus

75
Q

What fibre is the vagus nerve

A

pre-synaptic - does not synpase with any ganglia

76
Q

What plexus does the vagus nerve run with and what does it follow

A

runs within the coeliac plexus and then follows the arterial supply to the organs of the foregut

77
Q

Where does the vagus nerve synapse

A

with a short post-synpatic fibre within the wall of the target organ

78
Q

What does the posterior trunk of the vagus nerve do

A

passes down into the superior mesenteric plexus where this pre-synaptic fibre follows the branches of the superior mesenteric artery towards the midgut

79
Q

What does the posterior trunk of the vagus nerve synapse with

A

at the wall of the target organ with a post-synaptic fibre.

80
Q

Where do the pelvic splanchnic nerves come from

A

S2, S3 and S4 of the sacral spinal cord

81
Q

What does the pelvic splanchnic nerve run to

A

the hypogastric plexus

82
Q

What do the pelvic splanchnic nerves do within the inferior hypogastric plexus

A

ascend within the hypogastric nerves to the superior hypogastric plexus

83
Q

Where do the nerves from the superior hypogastric plexus run

A

towards the inferior mesenteric plexus and then towards the hindgut, alongside branches of the inferior mesenteric artery

84
Q

Where do the pelvic splanchnic nerves synapse

A

with a short post-synaptic fibre at the wall of the target organ

85
Q

What does the coeliac trunk supply

A

supplies the structures in the foregut: the stomach, proximal duodenum, spleen, liver and most of the pancreas

86
Q

Where does the coeliac trunk arise

A

right at the top of the aortic opening, between the crura of the diaphragm

87
Q

Name the 3 branches of the coeliac trunk

A

The small left gastric artery (goes straight up), common hepatic artery (goes to the right) and splenic arteries (goes to the left).

88
Q

How does the splenic artery goes towards the spleen

A

along the upper border of the pancreas

89
Q

How does the splenic artery end

A

by dividing into several large branches as it reaches the hilum of the spleen

90
Q

What does the common hepatic artery divide into

A

the hepatic artery and the gastro-duodenal artery

91
Q

Where does the hepatic artery run

A

upwards and to the right to supply the liver

92
Q

What structures are beneath the hepatic artery

A

common bile duct and portal vein (runs close to them)

93
Q

When and what does the hepatic artery divide into

A

right and left branches as it approaches the porta hepatis

94
Q

Where does the right gastric artery arise from

A

the hepatic artery

95
Q

Where does the right gastroepiploic artery arise from

A

the gastroduodenal artery

96
Q

After the gastroduodenal artery splits what does it continue as

A

the pancreaticoduodenal artery

97
Q

Where does the pancreaticoduodenal artery run

A

Runs downward behind the duodenum, supplying it and the head of the pancreas

98
Q

Where does the stomach get most of its blood from

A

2 arcades - 1 that runs in the greater omentum (by the greater curve) and 1 that runs in the lesser omentum (by the lesser curve)

99
Q

What supplies the arcade in the lesser omentum

A

right and left gastric artery

100
Q

What supplies the arcade in the greater omentum

A

left gastroepiploic and right gastroepiploic

101
Q

What do the right and left gastroepiploic arteries do

A

join together to form a continuous loop

102
Q

What 2 veins run with the superior mesenteric artery

A

splenic vein (in front) and left renal vein (behind)

103
Q

Where does the superior mesenteric artery run - till it gets to the pancreas

A

. It gives off branches to the pancreas and duodenum then emerges from beneath the pancreas, along with the superior mesenteric vein

104
Q

Where does the superior mesenteric artery run when it gets to the pancreas

A

It passes in front of the uncinate process of the pancreas and in front of the third part of the duodenum, as it does it gives off many branches

105
Q

Where do the branches of superior mesenteric artery enter

A

some enter the mesentery and 2 run down the retroperitoneum, 1 passes upward to the transverse mesocolon

106
Q

Where does the ileocolic artery go

A

towards the cecum

107
Q

Where does the right colic and the middle colic go

A

Go to the ascending and transverse colon

108
Q

What does the left colic artery supply

A

the ascending and distal part of the transverse colon

109
Q

Where does most of the stomach lie

A

above the costal margin

110
Q

What are the features of the jejunum compared to the ileum

A

is wider, thicker walled, large, tll and closely packed pliace circulares

111
Q

How is the jejunoileum attached to the posterior abdominal wall

A

by a mesentery that carries the blood vessels, nerves and lymphatics.

112
Q

Where does the mesentery of the jejunileum run

A

begins in front of the last part of the duodenum, runs downward and to the right, ending close to the cecum

113
Q

Describe the mucosal lining in the jejunum and the ileum

A

The mucosal lining is thrown into folds, that project into the ileum and are more pronounced jejunum

114
Q

What does the mucosal lining contain

A

lining contains projections (villi) to increase its surface area

115
Q

Where does the jejunum start

A

at the duodenojejunal flexure

116
Q

Where does the ileum join the large intestine

A

at the ileocecal valve

117
Q

What consists the portal triad

A

Anterior right – bile duct. Anterior, left – hepatic artery. Posterior – portal vein

118
Q

What are haustra in the large intestine

A

sacculations of the wall between the taeniae coli

119
Q

What are taeniae coli in the large intestine

A

3 bonds of the longitudinal layer of the smooth muscles in the wall

120
Q

What are appendices epiploicae in the large intestine

A

fatty projections