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Anatomy for Systems > Alimentary system > Flashcards

Alimentary system Flashcards

1
Q

At what vertebral level is the iliac crest?

A

L4

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2
Q

What two lines are used to divide the abdomen into 4 quadrants?

A

Transumbilical line

Median line/midsagittal line

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3
Q

What 4 lines are used to divide the abdomen into 9 quadrants?

A

Right midclavicular line
Left midclavicular line
Transtubercular line
Transpyloric line/subcostal line

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4
Q

What organs and structures are found in the right hypochondriac region of the abdomen?

A

Liver
Gallbladder
Small intestines

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5
Q

What organs and structures are found in the left hypochondriac region of the abdomen?

A

Spleen
Stomach
Pancreas
Colon

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6
Q

What organs and structures are found in the epigastric region of the abdomen?

A

Liver
Stomach
Pancreas
Duodenum

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7
Q

What organs and structures are found in the right lumbar region of the abdomen?

A

Ascending colon
Liver
Gallbladder

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8
Q

What organs and structures are found in the left lumbar region of the abdomen?

A

Descending colon

Left kidney

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9
Q

What organs and structures are found in the umbilical region of the abdomen?

A

Small intestine
Transverse colon
Umbilicus

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10
Q

What organs and structures are found in the right iliac/inguinal region of the abdomen?

A

Caecum

Appendix

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11
Q

What organs and structures are found in the left iliac/inguinal region of the abdomen?

A

Sigmoidal colon

Descending colon

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12
Q

What organs and structures are found in the hypogastric/suprapubic region of the abdomen?

A

Bladder
Sigmoidal colon
Female reproductive organs

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13
Q

List the 4 muscles of the anterior abdominal wall, their actions and their innervation

A

External oblique - compress and support abdominal viscera and flexes trunk; ventral rami of T7-T11 and subcostal nerves

Internal oblique - compress and support abdominal viscera; ventral rami of T7-T11, subcostal nerves + L1

Transversus abdominis - compress and support abdominal viscera; ventral rami of T7-T11 + subcostal nerves + L1

Rectus abdominis - compress and support viscera, flexes trunk and stabilises tilt of pelvis; anterior rami of T7-T12

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14
Q

Describe the arrangement of the abdominal muscles above and below the level of the umbilicus

A

Above umbilicus - rectus abdominis is enclosed either side by the rectus sheath (made up of EO, IO and TA)

Below umbilicus - aponeurosis of all 3 pass anteriorly to the rectus abdominis

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15
Q

What is the rectus sheath?

A

Formed by aponeurosis of the muscles of the abdomen - specifically EO, IO and TA

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16
Q

What is an aponeurosis?

A

Sheet of white fibrous tissue; takes place of a tendon in sheet like muscles and have a wide area of attachment

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17
Q

At what vertebral level is the umbilicus?

A

L3-L4

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18
Q

Which thoracic spinal segments innervate the anterior abdominal wall?

A

T7-T12

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19
Q

What dermatome supplies the level of the umbilicus?

A

T10

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20
Q

What dermatome supplies the level of the nipples?

A

T4

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21
Q

How is the inguinal canal formed?

A

Formed during the relocation of the gonads during foetal development

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22
Q

Describe the position of the inguinal canal in relation to the inguinal ligament

A

Lies parallel to and above the medial half of the inguinal ligament

Inguinal canal is found anterior to it too

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23
Q

What are the 2 bony attachments of the inguinal canal?

A

Anterior superior iliac crest

Pubic tubercle

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24
Q

Describe the borders/walls of the inguinal canal

A

Anterior - EO and IO
Posterior - Transversalis fascia
Roof - Transversalis fascia + Transversalis abdominus
Floor - Inguinal ligament

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25
Q

What is the relationship of the deep inguinal ring to the inferior epigastric vessels?

A

DIR is found lateral to inferior epigastric vessels

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26
Q

What type of inguinal hernia is more common in children?

A

Indirect inguinal hernias (congenital)

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27
Q

What type of inguinal hernia is more common in the elderly?

A

Direct inguinal hernias - due to muscle weakness

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28
Q

Describe the features of a direct inguinal hernia

A

Can be found and palpable on the abdomen
Found medial to inferior epigastric vessels
Typically found in the elderly due to muscle weakness
Bulges onto the posterior walls of the inguinal canal
Cannot descend into the scrotum

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29
Q

Describe the features of a indirect inguinal hernia

A

Typically found in children due to a congenital abnormally
Found lateral to the inferior epigastric vessels
Passes through inguinal canal
Can descend into the scrotum
Not palpable - behind EO

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30
Q

Where is the superficial inguinal ring found in relation to the pubic tubercle?

A

Found superolateral to the pubic tubercle

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31
Q

What are the superior epigastric vessels branches of?

A

Internal thoracic artery

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32
Q

What are the inferior epigastric vessels branches of?

A

External iliac artery

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33
Q

List the contents of the inguinal canal in males

A

Spermatic cord
Ilio-inguinal nerve
Blood and lympathics
Spermatic cord coverings

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34
Q

List the contents of the inguinal canal in females

A

Round ligament of the uterus
Ilio-inguinal nerve
Blood and lymphatics
Genitofemoral nerve

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35
Q

Which type of inguinal hernia is more common?

A

Direct hernias (acquired weakness rather than congenital weakness seen in direct hernias)

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36
Q

What % of inguinal hernias are direct?

A

1/3

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37
Q

Describe the 4 layers seen in the gut tube

A

Mucosa

  • epithelium
  • lamina propria
  • muscularis mucosae (MM)

Submucosa

Muscularis propria/externa - circular + longitudinal muscle

Serosa/adventitia

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38
Q

What are the four basic mucosal subtypes found in the GI tract, and give examples of each?

A

Protective - oral cavity, pharynx, oesophagus, rectum
Secretory - stomach
Absorptive - entire small intestines
Absorptive/protective - large intestine

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39
Q

Describe the histology of protective GI regions

A

Stratified squamous epithelium

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40
Q

Describe the histology of secretive GI regions

A

Stomach

Simple columnar epithelium with tubular glands

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41
Q

Describe the histology of the small intestine

A

Absorptive epithelium with villi and short glands

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42
Q

Describe the histology of the large intestines

A

Absorptive and protective role

Made up of closely packed straight glands with goblet cells

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43
Q

What are the 2 subdivisions of the peritoneum?

A

Parietal

Visceral

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44
Q

What is a mesentery?

A

Mesentery is a double layer of the peritoneum that encloses a structure

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45
Q

What is an omentum?

A

Momentum is a double layer of the peritoneum that connect the stomach to another viscus/organ

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46
Q

What is a peritoneal ligament?

A

Ligament is a double layer of the peritoneum that connects an organ to another or the posterior wall

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47
Q

What are the major divisions of the peritoneal cavity (sacs)?

A

Greater omentum

Lesser omentum

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48
Q

What is another name for the lesser omentum?

A

Omental bursa

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49
Q

How do the two omental sacs communicate?

A

Omental foramen/epiploic foramen

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50
Q

Give some examples of intraperitoneal organs

A 
Spleen
Stomach
Liver
Small intestines
Pancreas
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51
Q

Give some examples of retroperitoneal organs

A

SAD PUCKER

Suprarenal glands
Abdominal aorta
Duodenum
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum
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52
Q

What is present in the peritoneal cavity?

A

Space between the parietal and visceral perironeum
Filled with small volume (~50ml) of peritoneal fluid
No organs present in this space

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53
Q

Which layer of the peritoneum is sensitive to heat, pressure. cold and pain?

A

Parietal peritoneum

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54
Q

What are the attachments of the greater omentum?

A

Greater curvature of the stomach to the proximal duodenum

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55
Q

What are the attachments of the lesser omentum?

A

Lesser curvature of the stomach to the liver

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56
Q

Why is the greater omentum referred to as the abdominal policeman?

A

In infection, inflammatory exudate causes the omentum to adhere to the site of infection and wrap around it. This localises the infection to a small portion of the cavity, protecting against serious diffuse peritonitis

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57
Q

What innervation corresponds to pain felt by the parietal peritoneum?

A

T7-T12 and L1

Pain is well localised and useful in clinical diagnosis - rebound tenderness

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58
Q

Describe the innervation of pain impulses from the visceral peritoneum?

A

Innervated by autonomic nerves.

Pain is often referred and is dull and poorly localised.
As GI tract is a midline structure receiving bilateral nerve supply, pain is referred to the midline

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59
Q

List the posterior wall muscles of the abdomen

A

Psoas major
Quadratus lumbarum
Iliacus

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60
Q

List the organs and structures found on the posterior abdominal wall

A

Kidneys
Spleen
Pancreas
Duodenum

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61
Q

List the major nerves found in the posterior abdominal wall

A

Obturator nerve (L2-4) - passes through obturator foramen of pelvis

Femoral nerve (L2-L4) - found to emerge between psoas major and the iliac near the hip

62
Q

List the major blood vessels found in the posterior abdominal wall

A

Abdominal aorta
Inferior vena cava
Azygos vein

63
Q

Describe the nerve supply of the quadratus lumborum

A

Ventral rami of T12-L4

64
Q

What are the 3 major openings in the diaphragm and at what vertebral levels are they found?

A

Caval hiatus - T8
Oesophageal hiatus - T10
Aortic hiatus - T12

65
Q

What are the main 3 branches of the abdominal aorta that supplies blood to the gut tube within the abdominopelvic cavity, and at what vertebral level do they branch off?

A

Coeliac artery - T12
Superior mesenteric artery - L1
Inferior mesenteric artery - L3

66
Q

At what vertebral level does the abdominal aorta bifurcate into the 2 common iliac arteries?

A

L4

67
Q

How is the inferior vena cava formed?

A

Form at L5 when the 2 common iliac veins merge to form the IVC

68
Q

What does the celiac trunk divide into?

A

Left gastric artery
Splenic artery
Hepatic artery

69
Q

List some foregut structures

A

Abdominal oesophagus

Stomach

70
Q

List some midgut structures

A

Appendix
Small intestine
Ascending colon
Caecum

71
Q

List some hindgut structures

A

Large intestine

Rectum

72
Q

Which artery supplies the foregut?

A

Celiac trunk

73
Q

Which artery supplies the midgut?

A

Superior mesenteric artery

74
Q

Which artery supplies the hindgut?

A

Inferior mesenteric artery

75
Q

What is a portal system?

A

A portal venous system occurs when a capillary bed pools into another capillary bed through veins, without first going through the heart. Both capillary beds and the blood vessels that connect them are considered part of the portal venous system.

76
Q

The portal vein is formed by the fusion of what 2 veins?

A

Superior mesenteric vein

Splenic vein

77
Q

List the 4 sites of portocaval anastomosis in the body, and some complications related to these

A

Distal oesophagus - oesophageal varices
Rectal veins - haemorrhoids
Para-umbilicus veins - varices
Colic veins

78
Q

Describe the sympathetic nerve supply of the abdomen

A

Abdominopelvic splanchnic nerves

  • greater (T5-T9)
  • lesser (T10-T11)
  • least (T12)

Prevertebral sympathetic ganglia

Abdominal aortic plexus

79
Q

Describe the parasympathetic nerve supply of the abdomen

A

Anterior and posterior vagal trunks (CN X)

Pelvis splanchnic nerves (S2-S4)

80
Q

Between which vertebral levels are the kidneys found?

A

T12-L3

81
Q

What is the anterior to posterior arrangement of the contents of the hilum of the kidneys?

A

Vein
Artery
Pelvis of ureter

82
Q

Describe the 3 constriction sites of the ureters

A

At the junctions of the ureters and renal pelvis (pelviuretieric junction)

Where ureters cross the brim of the pelvic inlet

During passage through bladder wall

83
Q

At what vertebral level is the anterior superior iliac spine?

A

L4/L5

84
Q

Which region of the abdomen contains the right kidney?

A

Right lumbar region

85
Q

Describe the location of the spleen

A

Right hand side
Tip of 9th costal cartilage
Spleen parallel to 9-11th ribs
Lies in midaxillary line

86
Q

How long is the oesophagus, then specifically how long is the abdominal oesophagus?

A

Oesophagus is 25cm long; abdominal section is 1.25cm long

87
Q

Where does the oesophagus originate and extend to anatomically?

A

Starts at pharynx and ends at the stomach

88
Q

What are the 3 constrictions of the oesophagus?

A

Cervical - at the pharynx
Thoracic - caused by aortic arch
Diaphragmatic - oesophageal hiatus

89
Q

At what vertebral level is the oesophageal hiatus in the diaphragm?

A

T10

90
Q

At what vertebral level is the caval hiatus in the diaphragm?

A

T8

91
Q

At what vertebral level is the aortic hiatus in the diaphragm?

A

T12

92
Q

What structures transverse the oesophageal hiatus?

A

Oesophagus
Anterior and posterior vagal trunks
Oeosphageal branches of left gastric artery
lymphatic vessels

93
Q

What is the arterial blood supply of the oesophagus?

A

Branches of left gastric artery

94
Q

What is the venous drainage of the oesophagus?

A

Left gastric veins

95
Q

What is the lymphatic drainage of the oesophagus?

A

Left gastric lymph nodes (which drain into celiac lymph nodes)

96
Q

What is the pyloric sphincter?

A

Sphincter between stomach and duodenum - controls stomach emptying

97
Q

What is the pyloric sphincter formed from?

A

Thickening of the circular smooth muscle in the inner layer of the muscularis externa

98
Q

What are the rugae of the stomach formed from?

A

Gastric mucosa

99
Q

In what parts of the stomach are the rugae most prominent?

A

Pyloric part

Along greater curvature

100
Q

What group of lymph nodes ultimately drains the stomach?

A

Celiac lymph nodes

101
Q

What nerve is key in controlling gastric motility?

A

Vagus nerve

102
Q

What are the 3 parts of the small intestine in order of flow?

A

Duodenum
Jejunum
Ileum

103
Q

Where is the foregut/midgut boundary?

A

Found in 2nd region of duodenum near opening for bile duct

104
Q

How is the small intestines peritonised?

A

Duodenum - retro

Jejunum and ileum - intra

105
Q

Which part of the small intestines is the shortest, widest and most fixed?

A

Duodenum

106
Q

How can you tell between the jejunum and ileum?

A

Jejunum - deeper red, thick wall, higher vascularity, long vasa recta, few large arcades, less fat in mesentery; large tall and closely packed circular folds, few peyers patches

Ileum - paler pink, thin light walls, less vascular, short vasa recta, many short arcades, lots of fat in mesentery, smaller and widely separated circular folds, many peers patches

107
Q

Does the jejunum or ileum have many arterial arcades (loops)?

A

Ileum

108
Q

What features of the small intestines differentiates it from the small intestines?

A

Teniae coli - 3 thickened bands of longitudinal muscle

Haustra - sacculations/pouches of colon between tenure

Omental fatty appendages

109
Q

How are the different sections of the large intestine peritonised?

A 
Caecum - intra
Ascending - retro
Transverse - intra
Descending - retro
Sigmoid - intra
110
Q

Where is the boundary of the midgut and hindgut?

A

2/3 along transverse colon - remember differing blood supply

111
Q

What is McBurneys point?

A

Site of max tenderness in acute appendicitis

1/3 of distance from right iliac crest to umbilicus

112
Q

What is the most common position of the appendix?

A

Retrocecal

113
Q

What is the falciform ligament?

A

Ligament that attaches liver to anterior wall which separates the right and left lobes of the liver. Embryological remnant of the embryological ventral mesentery.

114
Q

What is the ligamentum teres?

A

Remnant of the umbilical vein of the foetus

Also known as round ligament of the liver

115
Q

What are the paracolic gutters and their clinical significance?

A

Spaces between colon and abdominal walls found lateral to the large intestines on both sides, which can allow the passage of infectious fluids from different compartments of the abdomen

116
Q

List 3 abdominal viscera which lie in the free edge of a mesentery

A

Intestines
Liver
Stomach

117
Q

How many muscle types are found in the muscularis externa of the oesophagus?

A

2 types

inner circular smooth muscle
outer longitudinal smooth muscle

118
Q

How many muscle types are found in the muscularis externa of the stomach?

A

3 types

inner circular SM
middle longitudinal SM
outer circular SM

119
Q

What kind of epithelium is found in the oesophagus?

A

Stratified squamous non-keratinised epithelium

120
Q

What secretory cells are found in the gastric pits?

A

Parietal cells - secrete Hal
Chief cells - pepsinogen
Goblet cells - mucus
Endocrine cells - gastrin

121
Q

What are the large folds that can be seen extending into the lumen of the small intestines called?

A

Plicae circulares

122
Q

Describe the epithelium of the small intestines

A

Simple columnar epithelium with villi

123
Q

How far do glands extend into the walls of the small intestine?

A

extends into lamina propria but not beyond muscularis mucosa/interna

124
Q

Where along the gut tube does the glands extend beyond the muscularis mucosae into the submucosa?

A

Oesophagus and duodenum

125
Q

In what layer of the walls of the gut tube are Peyers patches found?

A

Submucosa

Ileum and large intestines

126
Q

What are the predominant cell types found in the surface epithelium of the colon?

A

Goblet cells

H20 absorbing cells

127
Q

What type of epithelium is found in the colon?

A

Simple columnar

128
Q

What type of epithelium is found in the rectoanal junction?

A

Stratified squamous

129
Q

At what vertebral level is the transpyloric plane?

A

L1

130
Q

How would you locate the transpyloric plane on a patient?

A

One hand below xiphoid process

131
Q

What structures are present in the transpyloric plane?

A 
Pylorus of stomach
Tip of 9th costal cartilage
1st lumbar vertebrae
Liver
Colon
Neck of pancreas
132
Q

To which ribs is the spleen found alongside?

A

Ribs 9-11

133
Q

How is the spleen peritonised?

A

Intraperitoneal except at hilum

134
Q

What structures are found in the hilum of the spleen?

A

Splenic artery
Splenic veins
Splenic lymph nodes

135
Q

What are the functions of the spleen?

A

Storage of RBCs, platelets and WBCs
Creation of RBCs
Phagocytosis

136
Q

What vein is found posterior to the neck of the pancreas?

A

Portal vein

137
Q

Into which part of the duodenum does the pancreatic duct open into?

A

2nd part (ampulla) - alongside where bile duct empties into duodenum

138
Q

What connects the liver to the diaphragm?

A

Coronary ligament

139
Q

What is the porta hepatis?

A

Hilum of liver which contains:
Hepatic portal vein
Hepatic artery
Hepatic ducts

140
Q

What fold of the omentum wraps around the structures of the porta hepatis?

A

Lesser omentum

141
Q

Where is bile produced?

A

Liver

142
Q

Where is bile stored?

A

Gallbladder

143
Q

What is the function of bile?

A

Emulsification of fat

144
Q

What anatomical space should be carefully avoided during surgery to remove the gallbladder?

A

Calots triangle - theoretical triangle between cystic duct, common hepatic duct and inferior surface of liver, contains cystic artery

145
Q

Describe the main histological features of the pancreas

A

Islets of langerhans - clumps of poorly stained cells

Pure serous acini composed of large strongly stained cells

Small lobules surrounded by connective tissue septa

146
Q

Describe the main histological features of the liver

A

Cells are arranged in sheets and converge towards central vein

At the corner of these lobules there are portal triads

147
Q

What imaging technique can be used to examine the calyces, pelvises and ureters of the kidneys?

A

IV pyelogram

148
Q

What imaging can be used to examine the arteries of the abdomen, particularly around the kidneys?

A

Abdominal arteriogram

149
Q

What nerve is secretomotor to the stomach?

A

Vagus nerve (CN X)

150
Q

What lymph nodes drain the caecum?

A

Superior mesenteric lymph nodes

Anatomy for Systems (8 decks)

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