8. Gallbladder and Colon

Question 1

primary fx of the gallbladder is

Answer 1

to concentrate and store bile which is produced by the liver.

Question 2

the stored bile is then released from the gallbladder in response to

Answer 2

cholecystokinin

Question 3

anterior and superior to the gallbladder

Answer 3

inferior border of the liver and the anterior abdominal wall.

Question 4

posterior to the gallbladder

Answer 4

transverse colon and the proximal duodenum.

Question 5

inferior to the gallbladder

Answer 5

biliary tree and remaining parts of the duodenum.

Question 6

The gallbladder has a storage capacity of

Answer 6

30-50 mL

Question 7

gallbladder parts

Answer 7

fundus
body
neck

Question 8

the rounded, distal portion of the gallbladder. It projects into the inferior surface of the liver in the mid-clavicular line

Answer 8

fundus

Question 9

largest part of the gallbladder. It lies adjacent to the posteroinferior aspect of the liver, transverse colon and superior part of the duodenum.

Answer 9

body

Question 10

the gallbladder tapers to become continuous with the cystic duct, leading into the biliary tree.

Answer 10

neck

Question 11

contains a mucosal fold, known as Hartmann’s Pouch. This is a common location for gallstones to become lodged, causing cholestasis.

Answer 11

neck of the gallbladder

Question 12

is a series of gastrointestinal ducts allowing newly synthesised bile from the liver to be concentrated and stored in the gallbladder (prior to release into the duodenum).

Answer 12

biliary tree

Question 13

common hepatic duct runs along the

Answer 13

hepatic vein

Question 14

arterial supply of the gallbladder

Answer 14

cystic artery (b. of right hepatic artery)

Question 15

venous drainage of the gallbladder

Answer 15

Neck: cystic veins -> portal vein

Fundus , body: hepatic sinusoids

Question 16

innervation of the gallbladder

Answer 16

• coeliac plexus carries sympathetic and sensory fibres

* vagus nerve delivers parasympathetic innervation.

Question 17

lymph drainage of the gallbladder

Answer 17

Neck: cystic lymph nodes -> hepatic LN -> celiac LN

Question 18

uncomplicated gallstones

Answer 18

cholelithiasis

Question 19

typically right upper quadrant pain following a fatty meal as gallstones obstruct the cystic duct during contraction of the gallbladder. Not associated with systemic upset

Answer 19

biliary colic

Question 20

inflammation of the gallbladder. Pain is often associated with nausea, vomiting or fever

Answer 20

cholecystitis

Question 21

gallstone within the common bile duct. Often causes deranged liver function tests.

Answer 21

choledocholithiasis

Question 22

infection of the common bile duct often secondary to choledocholithiasis. Typically presents with right upper quadrant pain, fever and jaundice (Charcot’s Triad)

Answer 22

cholangtis

Question 23

Charcot’s triad

Answer 23

right upper quadrant pain, fever and jaundice

Question 24

surgical removal of the gallbladder

Answer 24

cholecystectomy

Question 25

triangle of Calot boundaries

Answer 25

1. liver -superior 2. cystic duct - inferior 3. common hepatic duct - medial

Question 26

cystic artery originates from

Answer 26

right hepatic artery

Question 27

common site of impacted gallstone (+) referred pain in the epigastric region

Answer 27

hepatopancreatic ampulla

Question 28

stimulation of visceral pain fibers that innervate GIT structure results in dull, aching, poorly localized pain that is referred over ___-

Answer 28

T5 to L1 dermatome

Question 29

Valve of houston is associated with what organ

Answer 29

rectum

Question 30

Anatomically, the colon can be divided into four parts

Answer 30

ascending, transverse, descending and sigmoid.

Question 31

the colon averages ___ cm in length

Answer 31

150 cm

Question 32

marks the start of the transverse colon.

Answer 32

right colic flexure/ right hepatic flexure

Question 33

at the left colic flexure/splenic flexure the colon is attached to the diaphragm by this ligament

Answer 33

phrenicolic ligament

Question 34

is the least fixed part of the colon, and is variable in position (it can dip into the pelvis in tall, thin individuals).

Answer 34

transverse colon

Question 35

unlike the ascending and descending colon, the transverse colon is

Answer 35

intraperitoneal

Question 36

transverse colon is enclosed by

Answer 36

transvese mesocolon

Question 37

left colic flexure is the start of

Answer 37

descending colon

Question 38

sigmoid colon ave length

Answer 38

40 cm

Question 39

sigmoid colon is located in this area of the abdomen

Answer 39

LLQ

Question 40

sigmoid colon extends from

Answer 40

left iliac fossa to S3

Question 41

The sigmoid colon is attached to the posterior pelvic wall by

Answer 41

a mesentery - sigmoid mesocolon

Question 42

are two spaces between the ascending/descending colon and the posterolateral abdominal wall.

Answer 42

paracolic gutters

Question 43

These structures are clinically important, as they allow material that has been released from inflamed or infected abdominal organs to accumulate elsewhere in the abdomen.

Answer 43

paracolic gutters

Question 44

small pouches of peritoneum, filled with fat, | attached to the surface of the large intestine

Answer 44

omental appendices

Question 45

Running longitudinally along the surface of the large bowel are three strips of muscle, known as the

Answer 45

taenia coli (mesocolic, free and omental coli.)

Question 46

Ascending colon and proximal 2/3 of the transverse colon –derived from the

Answer 46

midgut

Question 47

Distal 1/3 of the transverse colon, descending colon and sigmoid colon

Answer 47

hindgut

Question 48

midgut-derived structures are supplied by the

Answer 48

superior mesenteric artery

Question 49

hindgut-derived structures | are supplied by the

Answer 49

inferior mesenteric artery

Question 50

ascending colon receives arterial supply from

Answer 50

branches of the superior mesenteric artery; the ileocolic and right colic arteries. ileocolic artery gives rise to colic, anterior cecal and posterior cecal branches – all of which supply the ascending colon.

Question 51

transverse colon is derived from

Answer 51

both midgut and hindgut

Question 52

transverse colon is derived from both the midgut and hindgut, and so it’s arterial supply are

Answer 52

* Right colic artery (from the superior mesenteric artery) * Middle colic artery (from the superior mesenteric artery) * Left colic artery (from the inferior mesenteric artery)

Question 53

arterial supply of the descending colon

Answer 53

the left colic artery (b. of inferior mesenteric artery )

Question 54

The sigmoid colon receives arterial supply via

Answer 54

sigmoid arteries (branches of the inferior mesenteric artery).

Question 55

is a clinically important vessel that provides collateral supply to the colon – thereby maintaining arterial supply in the case of occlusion or stenosis of one of the major vessels.

Answer 55

Marginal Artery of Drummond

Question 56

As the terminal vessels of the superior mesenteric and inferior mesenteric artery approach the colon, they split into many branches, which anastomose with each other. These anastomoses form a continuous arterial channel which extends the length of the colon called

Answer 56

marginal artery

Question 57

Long, straight arterial branches arise from the marginal artery to supply the colon,called

Answer 57

vasa recta

Question 58

venous drainage of the ascending colon

Answer 58

ileocolic and right colic veins–> superior mesenteric vein.

Question 59

venous drainage of the transverse colon

Answer 59

middle colic vein, –> superior mesenteric vein.

Question 60

venous drainage of the descending colon

Answer 60

left colic vein–> inferior mesenteric vein.

Question 61

venous drainage of the sigmoid colon

Answer 61

drained by the sigmoid veins into the inferior mesenteric vein.

Question 62

The superior mesenteric and inferior mesenteric veins ultimately empty into the

Answer 62

hepatic portal vein

Question 63

Midgut-derived structures (ascending colon and proximal 2/3 of the transverse colon) receive their sympathetic, parasympathetic and sensory supply via

Answer 63

nerves from the superior mesenteric plexus.

Question 64

Hindgut-derived structures (distal 1/3 of the transverse colon, descending colon and sigmoid colon) receive their sympathetic, parasympathetic and sensory supply via nerves from the

Answer 64

inferior mesenteric plexus •Parasympathetic innervation via the pelvic splanchnic nerves •Sympathetic innervation via the lumbar splanchnic nerves.

Question 65

The lymphatic drainage of the ascending and transverse colon is into the

Answer 65

superior mesenteric nodes

Question 66

Lymphatic: The descending colon and sigmoid drain into the

Answer 66

inferior mesenteric nodes.

Question 67

Most of the lymph from the superior mesenteric and inferior mesenteric nodes passes into the intestinal lymph trunks, and on to the cisterna chyli – where it ultimately empties into the

Answer 67

thoracic duct

Question 68

sacculations of the large intestine

Answer 68

haustra

Question 69

fatty tags of the large intestine

Answer 69

appendices epiploicae

Question 70

transverse colon | caliber

Answer 70

38 cm

Question 71

sigmoid colon caliber

Answer 71

25-38 cm

Question 72

caliber | descending colon

Answer 72

25 cm

Question 73

rectum caliber

Answer 73

13 cm

Question 74

ascending colon caliber

Answer 74

13 cm

Question 75

anal colon caliber

Answer 75

4 cm

Question 76

blood supple of the cecum

Answer 76

SMA-> ileocolic a. -> anterior/posterior cecal a.

Question 77

venous drainage of cecum

Answer 77

anteiror/posterior cecal v. -> ileocolic v. -> SMV

Question 78

The appendix originates from the

Answer 78

posteromedial aspect of the cecum

Question 79

appendix is supported by

Answer 79

mesoappendix, a fold of mesentery which suspends the appendix from the terminal ileum.

Question 80

position of the free-end of the appendix is highly variable and can be categorised into seven main locations depending on its relationship to the ileum, caecum or pelvis

Answer 80

Pre-ileal – anterior to the terminal ileum – 1 or 2 o’clock. Post-ileal – posterior to the terminal ileum – 1 or 2 o’clock. Sub-ileal – parallel with the terminal ileum – 3 o’clock. Pelvic – descending over the pelvic brim – 5 o’clock. Subcecal – below the cecum – 6 o’clock. Paracecal – alongside the lateral border of the cecum – 10 o’clock. Retrocecal – behind the cecum – 11 o’clock.

Question 81

the most common position of the appendix

Answer 81

retrocecal

Question 82

The appendix is derived from the embryologic

Answer 82

midgut

Question 83

the vascular supply of the appendix

Answer 83

SMA -> ileocolic a -> appendicular artery

Question 84

the venous drainage of the appendix

Answer 84

appendicular vein

Question 85

lymphatic drainage of the appendix

Answer 85

ileocolic lymph nodes (which surround the ileocolic artery).

Question 86

etiology of appendicitis

Answer 86

In the young –increase in lymphoid tissue size, which occludes the lumen. From 30 years old onwards – blocked due a faecolith.

Question 87

this nerve maybe injured in appendectomy

Answer 87

iliohypogastric nerve -> weakening of anterior abdominal wall

Question 88

* the sigmoid colon twists around the sigmoid mesocolon and may become obstructed * patient experience left sided colicky pain, abdominal distention, hematochezia (compromise of sigmoid arteries)

Answer 88

sigmoid volvulus

Question 89

refers to a diverticula that are not inflamed

Answer 89

diverticulosus

Question 90

* inflamed diverticula, contents may irritate the parietal peritoneum, resulting in pain that is localized to the LLQ * may have hematochezia

Answer 90

diverticulitis