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Lecture 6 Flashcards

1
Q

What comes off the abdominal aorta at the T12 level?

A

Coeliac Trunk.

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2
Q

What comes off the Coeliac trunk?

A

Left.Gastric artery.
Splenic artery.
Common Hepatic artery.

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3
Q

What comes off the abdominal aorta at the L1 level?

A

Superior Mesenteric artery.

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4
Q

What comes off the abdominal aorta at the L3 level?

A

Inferior Mesenteric artery.

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5
Q

What comes off the abdominal aorta at the L4 level?

A

Right and Left Common Iliac artery.

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6
Q

What structures are apart of the foregut?

A 
Distal 1/2 Oesophagus. 
Stomach.
Pancreas.
Liver.
Biliary Apparatus. 
Proximal 1/2 Duodenum.
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7
Q

What is the arterial supply of the foregut?

A

Branches of the Coeliac axis (Abdominal aorta at T12).

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8
Q

What is the venous drainage of the foregut?

A

Portal vein.

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9
Q

What is the nerve supply of the foregut?

A

Coeliac Plexus at T12.

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10
Q

What are the lymphatics of the foregut?

A

Pre-aortic nodes at T12 (called coeliac nodes).

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11
Q

What is the pain referred to in the foregut?

A

Epigastric region.

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12
Q

What is the general region of the stomach (surface anatomy)?

A

Epigastric (to the left of the midline).

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13
Q

Where is the fundus (surface anatomy)?

A

Rib 5/6.

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14
Q

Where is the oesophagus (surface anatomy)?

A

Costal cartilage 7/8.

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15
Q

Where is the pylorus (surface anatomy)?

A

L1 vertebral level.

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16
Q

How many layers are in the muscularis externa of the stomach?

A

There are three.
Outer = longitudinal.
Middle = Circular.
Oblique = Inner.

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17
Q

What lines the inner wall of the muscularis externa?

A

Rug. These increase the surface area.

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18
Q

What are the three parts of the stomach?

A

Fundus.
Body.
Pylorus.

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19
Q

What arteries supply the lesser curvature of the stomach?

A

Left Gastric and Right Gastric.

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20
Q

What does the left gastric artery branch off from?

A

Coeliac trunk.

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21
Q

What does the right gastric artery branch off from?

A

Common Hepatic.

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22
Q

What arteries supply the greater curvature of the stomach?

A

Left Gastro-omental and Right Gastro-omental.

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23
Q

What does the left gastro-omental artery branch off from?

A

Splenic artery.

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24
Q

What does the right gastro-omental artery branch off from?

A

Gasproduodenal which branches off from the Common Hepatic artery.

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25
Q

What is tricophagia?

A

It is a psychological condition of eating hair - it is associated with trichotillomania (pulling out hair).

If enough hair is ingested a hair ball can form - trichobezoar.

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26
Q

What can tricophagia cause?

A

Indigestion and stomach pain.

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27
Q

Where does the duodenum originate?

A

Immediately following the pyloric region of the stomach.

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28
Q

Where is the 1st part of the duodenum?

A

It is in the Transpyloric Plane (L1) it is superior.

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29
Q

Describe the 1st part (in terms of peritoneum)?

A

It is intraperitoneal.

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30
Q

Where is the 2nd part of the duodenum ?

A

It wraps around the head of the pancreas. It is on the right hand side of the midline, and it is descending.

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31
Q

Describe the 2nd part (in terms of peritoneum)?

A

It is retroperitoneal.

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32
Q

Where is the 3rd part of the duodenum?

A

It crosses back over the Inferior Vena Cava (IVC) and the Aorta. It is inferior.

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33
Q

Describe the 3rd part (in terms of peritoneum)?

A

It is retroperitoneal.

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34
Q

Where is the 4th part of the duodenum?

A

It ascends to the Duodenojejunal flexure, which is on the left hand side of the midline. It is ascending.

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35
Q

Describe the 4th part (in terms of peritoneum)?

A

Retroperitoneal.

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36
Q

What happens halfway along the duodenum?

A

The foregut transitions to the midgut. The blood, nerves and lymphatics change.

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37
Q

What artery supplies the superior half of the duodenum?

A

Superior Pancreatoduodenal branches. These come from the Gasproduodenal artery, which comes from the Common Hepatic artery which comes form the Coeliac trunk.

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38
Q

What artery supplies the inferior half of the duodenum?

A

Inferior Pancreatoduodenal branches. These come from the Superior Mesenteric Origin.

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39
Q

What is the ANS nervous supply for the superior half of the duodenum?

A

Coeliac Plexus at T12.

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40
Q

What is the ANS nervous supply for the inferior half of the duodenum?

A

Superior Mesenteric Plexus at L1.

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41
Q

What is the venous drainage of the superior half of the duodenum?

A

Direct to the Portal Vein.

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42
Q

What is the venous drainage of the inferior half of the duodenum?

A

Superior Mesenteric vein (SMV).

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43
Q

What is the lymphatic drainage of the superior half of the duodenum?

A

Pre-aortic coeliac nodes at T12.

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44
Q

What is the lymphatic drainage of the inferior half of the duodenum?

A

Pre-aortic Superior Mesenteric nodes at L1.

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45
Q

What is the Ampulla of Vater?

A

Union of Common Bile Duct and Main Pancreatic Duct.

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46
Q

Where does the Major Duodenal Papilla enter?

A

Through the wall of the Descending Duodenum (2nd Part).

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47
Q

What does the Major Duodenal Papilla control?

A

The flow of bile (from the liver) and pancreatic juice (from the pancreas) into the duodenum via the Sphincter of Oddi.

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48
Q

What are the structures of the midgut?

A 
Distal 1/2 of duodenum. 
Jejunum.
Ileum.
Caecum and Appendix. 
Ascending colon.
2/3 Transverse colon.
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49
Q

What is the arterial supply of the midgut?

A

Branches of Superior Mesenteric artery. Abdominal aorta at L1.

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50
Q

What is the venous drainage of the midgut?

A

Superior Mesenteric Vein.

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51
Q

What is the nervous supply of the midgut?

A

Superior Mesenteric Plexus, at L1.

52
Q

What is the lymphatic drainage of the midgut?

A

Pre-aortic Superior Mesenteric nodes at L1

53
Q

How long is the small intestine?

A

6m long.

54
Q

What occurs at the small intestine?

A

Majority of digestion.

55
Q

The small intestine is converted into what parts?

A

Jejunum (proximally):
-2/5 of the small intestine length.
Ileum (distally):
-3/5 of the small intestine length.

56
Q

What is the small intestine suspended by?

A

It is suspended from the body wall via a mesentery.

57
Q

Describe the mesentery?

A

It is a fan-shaped folds of peritoneum which enclose the gut tube. It allows for ingress/egress of vessels, nerves and lymphatics.

58
Q

Describe the arterial arcade patterning in the Jejunem?

A

1 or 2 arcades with long branches.

59
Q

Describe the arterial arcade patterning in the Ileium?

A

More arcades with many short branches.

60
Q

Where does the transition occur from Midgut to Hindgut?

A

2/3 along the Transverse Colon.

61
Q

What are the parts of the Large intestine?

A

[From midgut to hindgut]:

*Appendix.
Caecum.
Ascending Colon. 
Hepatic Flexure.
Transverse Colon.  
Splenic Flexure.
Descending Colon.
Sigmoid Colon.
62
Q

What is pain referred to in the Large intestine?

A 
Midgut = Umbilical region.
Hindgut = Suprapubic.
63
Q

What is the function of the Large Intestine?

A

Absorb water and electrolytes.

Store undigested material until expelled by the body.

64
Q

What are the Haustra?

A

Sacculations of the wall.

65
Q

What are the appendices epiploicae?

A

Fatty tags.

66
Q

What are the Teniae Coli?

A

Longitudinal muscles collected into 3 bands (continuous with smooth muscle of small intestine).

67
Q

Where is the large intestine found in the surface anatomy?

A

All regions except umbilical.

68
Q

Where is the caecum/appendix (in terms of surface anatomy)?

A

Right groin.

69
Q

Where is the Hepatic flexure (in terms of surface anatomy)?

A

Right hypochondrium. Inferior to the liver.

70
Q

Where is the Splenic flexure (in terms of surface anatomy)?

A

Left hypochondriac. Anterior to the spleen.

71
Q

Where is the Sigmoid colon (in terms of surface anatomy)?

A

Left groin.

72
Q

What is the arterial supply for the caecum/appendix?

A

Caecal and Appendicular arteries.

73
Q

Where do Caecal and Appendicular arteries branch from?

A

Ileocolic artery.

74
Q

What is the arterial supply for the ascending colon?

A

Right Colic artery.

75
Q

What is the arterial supply for the proximal 2/3 Transverse colon?

A

Middle Colic and Marginal artery.

76
Q

What does the Superior Mesenteric Artery form?

A

Caecal and Appendicular arteries.
Right Colic artery.
Middle Colic and Marginal artery.

77
Q

What is the arterial supply for the distal 1/3 Transverse colon?

A

Marginal and Left Colic artery.

78
Q

What is the arterial supply for the descending colon?

A

Left Colic artery.

79
Q

What is the arterial supply for the sigmoid colon?

A

Sigmoid artery.

80
Q

What is the significance about the marginal artery?

A

It is the anastomotic point between Superior and inferior Mesenteric arteries.

81
Q

Arterial supply of the midgut?

A

Branches of Superior Mesenteric artery, at L1.

82
Q

ANS Nervous supply of the midgut?

A

Superior Mesenteric Plexus, at L1.

83
Q

Venous drainage of the the midgut?

A

Superior Mesenteric Vein.

84
Q

Lymphatic drainage of the midgut?

A

Pre-aortic superior mesenteric nodes at L1.

85
Q

Arterial supply of the hindgut?

A

Branches of Inferior Mesenteric artery, at L3.

86
Q

ANS Nervous supply of the hindgut?

A

Inferior Mesenteric Plexus, at L3.

87
Q

Venous drainage of the hindgut?

A

Inferior Mesenteric Vein.

88
Q

Lymphatic drainage of the hindgut?

A

Pre-aortic inferior mesenteric nodes, at L3.

89
Q

When does the sigmoid colon become the rectum?

A

S3 vertebral level.

90
Q

Where does the rectum go?

A

It pierces the pelvic diaphragm (at the tip of the coccyx) to become the anal canal.

91
Q

Describe the superior 1/3 of the Rectum (in terms of peritoneum)?

A

Covered in visceral peritoneum.

92
Q

Describe the middle 1/3 of the Rectum (in terms of peritoneum)?

A

Peritoneum on the anterior surface only.

93
Q

Describe the inferior 1/3 of the Rectum (in terms of peritoneum)?

A

Infra peritoneal.

94
Q

What is the arterial supply of the superior 1/3 of the rectum?

A

Superior rectal branches of Inferior Mesenteric Artery (at L3).

95
Q

What is the arterial supply of the middle 1/3 of the rectum?

A

Middle rectal branch of Internal Iliac artery.

96
Q

What is the arterial supply of the inferior 1/3 of the rectum?

A

Inferior rectal branch of the Internal Pudendal.

97
Q

What is the ANS nervous supply of the proximal 1/3 of the rectum?

A

Inferior Mesenteric Plexus at L3.

98
Q

What is the ANS nervous supply of the distal 2/3 of the rectum?

A

Inferior Hypogastric Plexus.

99
Q

What is the lymphatic drainage of the proximal 1/3 of the rectum?

A

Pre-aortic nodes at L3.

100
Q

What is the lymphatic drainage of the distal 2/3 of the rectum?

A

Internal iliac nodes.

101
Q

What is the venous drainage of the superior 1/3 of the rectum?

A

Superior rectal vein.

102
Q

Where do the superior rectal veins one from?

A

Inferior Mesenteric Vein, which comes from splenic vein, which comes from the portal vein.

103
Q

What is the venous drainage of the middle 1/3 of the rectum?

A

Middle Rectal vein.

104
Q

Where does the middle rectal vein come from?

A

Internal iliac, which comes from Common iliac which comes from Inferior Vena Cava.

105
Q

What is the venous drainage of the inferior 1/3 of the rectum?

A

Inferior rectal vein.

106
Q

Where does the inferior rectal vein come from?

A

Internal iliac, which comes from Common iliac which comes from Inferior Vena Cava.

107
Q

Describe the portal venous system?

A

Superior Mesenteric Vein goes directly to the Portal vein; inferior mesenteric vein goes to the splenic vein which goes to the portal vein. Portal vein goes to the Liver.

108
Q

Where is portal vein formed at?

A

L1 - Trans-pyloric plane.

109
Q

What does the Parasympathetic system supply to the gut?

A

Vagus nerve (CN X) and Pelvic Splanchnic nerves S2-4.

110
Q

What does the Sympathetic system supply to the gut?

A

Thoracic, lumbar and sacral splanchnic nerves (from T5-L2 sympathetic ganglia).

111
Q

What does the ANS control in the gut?

A

Viscera, glans, blood vessels.
Smooth muscle.
Non-conscious control.
Motor and sensory.

112
Q

Describe the ANS to the foregut?

A 
Plexus = Coeliac. 
Sympathetic = Greater Splanchnic (T5-T9).
Parasympathetic = Vagus [X].
113
Q

Describe the ANS to the midgut?

A 
Plexus = Superior Mesenteric.
Sympathetic = Lesser splanchnic (T10-T11).
Parasympathetic = Vagus [X].
114
Q

Describe the ANS to the aorticorenal?

A 
Plexus = Renal. 
Sympathetic = Least splanchnic (T12).
Parasympathetic = Vagus [X].
115
Q

Describe the ANS to the hindgut?

A 
Plexus = Inferior Mesenteric/Superior Hypogastric.
Sympathetic = Lumbar/Sacral splanchnic (L1&2/S2-4). 
Parasympathetic = S2-S4.
116
Q

Describe the AND to the pelvic organs?

A 
Plexus = Inferior/Superior Hypogastric.
Sympathetic = Sacral splanchnic (S2-S4).
Parasympathetic = Pelvic splanchnic (S2-S4).
117
Q

Where is pain referred to?

A

Back to the origin spinal levels of the sympathetic supply via afferent fibres and then via the dorsal root.

118
Q

Is there is a specific pain reference?

A

No there isn’t, so pain is spread around the corresponding dermatome.

119
Q

Where is pain referred to in the foregut region?

A

Epigastric region.

T5-T9 (Greater splanchnic).

120
Q

Where is pain referred to in the midgut region?

A

Umbilical region.

T10-T11 (Lesser splanchnic).

121
Q

Where is pain referred to in the hindgut region?

A

Suprapubic region.

L1/L2 (Lumbar/Sacral splanchnic).

122
Q

What happens in an appendicitis?

A

The appendix becomes enflamed.

123
Q

Where does the pain refer back to in an appendicitis?

A

The afferent sympathetic fibres refer back to T10-T11 dermatomes.

124
Q

Where is pain experienced?

A

The broad diffuse pain is experienced around the umbilical region.

125
Q

What happens when appendix becomes more enflamed?

A

The appendix starts to press on the parietal peritoneum of the body wall - this is known as somatic sensory supply.

126
Q

Where is pain felt after the appendix is enflamed?

A

It is felt as acute and localised int he lower right quadrant.

DS (32 decks)

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