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Anatomy Flashcards

1
Q

What is mastication

A

Chewing, by movement of jaw and tongue

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2
Q

Function of buccinator

A

Thin, quadrilateral muscle occupying lateral wall of cavity. Helps push food side to side

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3
Q

How are adult teeth classified

A

Maxilla and mandible can be split into two equal halves consisting of 8 teeth a side. Each quadrant has Incisor (2), Canine (1), Premolar (2) and Molars (3). 32 teeth in total

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4
Q

Temperomandibular joint articulations

A

Articular tubercle, of temporal bone with condylar process of mandible in the mandibular fossa

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5
Q

What nerve supplies the muscles of mastication

A

Mandibular division of trigeminal nerve, CN V3

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6
Q

Muscles of mastication

A

Temporalis, Masseter, Lateral (Close) and Medial Pterygoid

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7
Q

Course of CN V3

A

Mandibular division of trigeminal nerve, from pons, through foramen ovale, to muscles of mastication and sensory area

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8
Q

What tonsils are present between arches of soft palate

A

Palatine tonsils

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9
Q

What nerve is responsible for taste and which for general sensation in the tongue

A

CN VII - Facial nerve for taste and CN V3 - Mandibular division of trigeminal nerve for general

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10
Q

Which papillae are responsible for taste

A

Medial to lateral - Fungiform, Vallate and Foliate

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11
Q

Which papillae are responsible for general sensory

A

Filiform

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12
Q

Course of facial nerve

A

CN VII, from pontomedullary junction. Travel though internal acoustic meatus then stylomastoid foramen.

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13
Q

What does the facial nerve supply

A

Anterior 2/3rd of tongue, taste. Muscles of facial expression and glands in floor of mouth

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14
Q

How is the tongue innervated

A

The anterior 2/3rd of the tongue has sensory innervation from the lingual nerve. This is a branch of the mandibular division of the trigeminal nerve along with the Chorda Tympani (part of facial nerve carrying taste information)

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15
Q

Nerve supply to superior oral cavity

A

Maxillary nerve, CN V2

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16
Q

Nerve supply to inferior oral cavity

A

Mandibular nerve, CN V3

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17
Q

Sensory part of gag reflex vs motor part

A

Sensory part of the gag reflex is carried by nerve fibres CN IX (Glossopharyngeal nerve) and motor part by CN IX and CN X (Vagus nerve)

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18
Q

What nerves are blocked when anaesthetic is sprayed in the oral cavity

A

CN V2, CN V3, CN VII and CN IX

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19
Q

Does a conscious person have a gag reflex

A

No

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20
Q

Course of maxillary nerve

A

From pons through foramen rotundum to sensory area of mid face

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21
Q

Course of CN IX

A

Glossopharyngeal nerve, From medulla through jugular foramen to posterior wall of oropharynx (sensory), parotid gland (secretomotor) and posterior 1/3rd of tongue (sensation and taste)

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22
Q

Where does the parotid gland secrete into

A

Upper 2nd molar

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23
Q

Where does the submandibular gland secrete

A

Enters floor of mouth and secretes via lingual caruncle

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24
Q

Where does the sublingual gland secrete

A

Sublingual caruncle in the floor of the mouth

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25
Q

Nerve supply to the salivary glands

A 
CN IX (Glossopharyngeal) to Parotid gland
CN VII (Facial nerve) to submandibular and sublingual
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26
Q

4 pairs of intrinsic skeletal muscles of tongue

A

Superolaterally to Inferiolaterally -

Palatoglossus, Styloglossus, Hyoglossus, Genioglossus

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27
Q

What innervates the intrinsic tongue muscles

A

CN XII, Hypoglossal nerve except for palatoglossus

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28
Q

Course of CN XII

A

Hypoglossal nerve, From medulla through hypoglossal canal. Innervate extrinsic and intrinsic muscles of tongue except Palatoglossus

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29
Q

What innervates the Pharynx

A

CN X, Vagus nerve

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30
Q

What nerve runs along the carotid artery

A

Vagus nerve

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31
Q

Where is the Cricopharyngeus sphincter present

A

Upper oesophageal sphincter, C6

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32
Q

What aspects help prevent drooling

A

Orbicularis oris and CN VII - Facial nerve

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33
Q

Anatomy of swallowing

A

Orbicularis oris and CN VII (Facial nerve) prevent drooling. Tongue (CN XII - Hypoglossal nerve) pushes bolus towards oropharynx. Contraction of pharyngeal constrictor muscles push bolus towards oesophagus (CN X - Vagus nerve). Inner longitudinal layers (CN IX - Glossopharyngeal and CN X) close off laryngeal inlet to prevent aspiration. Bolus reach oesophagus

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34
Q

What part of the ANS speeds up peristalsis

A

Parasympathetic

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35
Q

Where does the oesophagus begin

A

C6 - Cricopharyngeus muscle

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36
Q

What causes thoracic constriction of oesophagus

A

Arch of aorta and left main bronchus

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37
Q

What causes diaphragmatic constriction of oesophagus

A

Passing through diaphragm, physiological sphincter

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38
Q

Use of lower oesophageal sphincter

A

Prevent occurrence of “reflux”

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39
Q

Hepatic vs Splenic flexure

A

Hepatic flexure is between ascending and transverse colon whereas splenic flexure is between transverse and descending colon

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40
Q

Range of foregut, midgut and hindgut

A

Foregut - Oesophagus to 1/2 pancreas
Midgut - 1/2 pancreas to 2/3rd transverse colon
Hindgut - 2/3rd transverse colon to anal canal

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41
Q

What happens to abdominal muscles during peritonitis

A

Muscles contract to ‘guard’ inner organs from pain of pressure upon them

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42
Q

What is retroperitoneal

A

Visceral peritoneum anterior surface only, Pancreas, Ascending and Descending colon, kidneys, adrenal glands

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43
Q

Types of peritoneal formations

A

Mesentery, omentum and peritoneal ligaments

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44
Q

What is the greater and lesser omentum

A

Greater omentum is from greater curvature of stomach to the transverse colon. Covers organs like an apron. Lesser omentum is from lesser curvature of stomach and duodenum to the liver. Has free edge

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45
Q

Which GI organs have a mesentery

A

Mesentery proper - Small intestine
Transverse and sigmoid mesocolon
Mesoappendix

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46
Q

Function of mesentery

A

Provide blood and lymph vessels, nerves, lymph nodes, fat and mobility

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47
Q

What does the free edge of lesser omentum contain

A

Portal triad - Hepatic portal vein, Hepatic artery proper and bile duct

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48
Q

What is the pringle maneuvre

A

Fingers are inserted though the Omental Foramen (Foramen of Winslow) and hemostat is used to clamp hepatoduodenal ligament to control bleed from liver

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49
Q

Pouch formed by peritoneum in males

A

Recto-uterine pouch

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50
Q

Pouch formed by peritoneum in females

A

Vesico-uterine and Recto-uterine pouch

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51
Q

What is Ascites

A

Collection of fluid in the peritoneal cavity usually caused by liver cirrhosis an portal hypertension

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52
Q

How can Ascites be solved

A

By abdominocentesis

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53
Q

Auscultation patterns for Ascites

A

Tympany above fluid level, dullness at fluid

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54
Q

Why is the needle placed lateral to abdominal sheath in abdominocentesis

A

To avoid inferior epigastric artery

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55
Q

What does visceral pain feel like

A

Dull, achy, nauseating, hard to localize

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56
Q

What does parietal pain feel like

A

Sharp, stabbing, easy to pinpoint

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57
Q

What is colicky pain

A

Pain that comes and goes. Due to GI tract obstruction

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58
Q

What spinal levels do sympathetics leave spinal cord to get to abdominal organs

A

T5 to L2 within abdominopelvic splanchnic nerves. Synapse at prevertebral ganglia which are located anterior to aorta at exit points of the major branches

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59
Q

Sympathetic innervation of adrenal glands

A

Sympathetic fibres leave at T10-L1. Enter abdominopelvic splanchnic nerve and carried with prearterial plexus to adrenal gland. Don’t synapse at prevertebral ganglia.

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60
Q

What supplies parasympathetics to the GI tract and distal end of transverse colon

A

Vagus nerve - CN X, foregut and midgut

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61
Q

What supplies parasympathetics from descending colon to anal canal

A

Pelvic Splanchnic Nerves (S2 - S4), hindgut

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62
Q

Where does pain in foregut tend to be felt

A

Epigastric regon

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63
Q

Where does pain in midgut tend to be felt

A

Umbilical region

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64
Q

Where does pain in hindgut tend to be felt

A

Pubic region

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65
Q

Where visceral afferents from foregut enter spinal cord

A

T6 - T9

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66
Q

Where visceral afferents from midgut enter spinal cord

A

T8 - T12

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67
Q

Where visceral afferents from hindgut enter spinal cord

A

T10 - T12

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68
Q

Why does liver/gallbladder pain radiates to right shoulder/trapezius

A

Liver/gallbladder are situated on top of the diaphragm. The diaphragm is innervated by C2, C3 and C4. This has dermatomes on the right upper shoulder.

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69
Q

Why is kidney and ureter pain felt in inguinal region

A

These are innervated by the Iliohypogastric and Ilioinguinal nerves which have dermatones at L1, region of inguinal canal

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70
Q

Abdominal part of body wall nerves

A

Thoracoabdominal nerves - T7 to T11
Subcoaster nerve - T12
Iliohypogastric nerve - Half of L1 anterior ramus
Ilioinguinal nerve - Other half of L1 anterior ramus

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71
Q

Why does appendicitis pain transition from dull, achy to sharper pain in right Iliac fossa

A

Appendix is a structure in the midgut. This is innervated by T8-T12 and pain is felt ass visceral in the umbillical region. As appendicitis worsens, it starts to push against the parietal peritoneum part of the soma. This causes parietal pain in the right Iliac fossa.

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72
Q

Sharp, stabbing pain in right Iliac fossa

A

Exacerbation of Appendicitis

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73
Q

What is Icterus

A

Jaundice, yellowing of skin and Sclera (white part eye)

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74
Q

What causes Icterus

A

Increased levels of Bilirubin

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75
Q

How is Bilirubin normally produced

A

By breakdown of RBCs in the Spleen

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76
Q

Role of gallbladder

A

Storage and concentration of Bile

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77
Q

Where is bile produced

A

Liver by the use of Bilirubin

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78
Q

Function of Bile

A

Absorption of fats in small intestine

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79
Q

What is the hepatopancreatic duct

A

Ampulla of Vater, formed by common bile duct and pancreatic duct. Secretes bile and pancreatic enzymes into the duodenum.

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80
Q

Which ribs protect the liver

A

Ribs 7 - 11

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81
Q

Liver lobes

A

4 anatomical - Right, Left, Caudate and Quadrate

8 functional relating to vasculature and bile drainage

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82
Q

Site of entrance of portal triad into liver

A

Porta hepatis

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83
Q

What ligament attaches liver to anterior body wall

A

Falciform ligament

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84
Q

What ligament is a remnant of the umbilical vein, liver

A

Round ligament of the liver

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85
Q

Drainage of blood from liver

A

Portal vein and hepatic artery blood mix into the sinusoids. This returns to hepatic veins which come together as 3 veins to drain to the Inferior Vena Cava

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86
Q

Which ligament contains the portal triad

A

Hepatoduodenam ligament

87
Q

What level does Coeliac trunk leave aorta

A

T12

88
Q

Branches of Coeliac trunk

A

Common Hepatic Artery, Left Gastric and Splenic

89
Q

Location of spleen

A

Intraperitoneal organ in Left Hypochondrium

90
Q

Which ribs protect the Spleen

A

Ribs 9 - 11

91
Q

Function of Spleen

A

Breakdown of RBCs to form Bilirubin

92
Q

Blood supply of stomach at junction of lesser curvature and lesser omentum

A

Right and Left Gastric that anastomose together

93
Q

Where do the right and left Gastric artery arise from

A

Hepatic Artery Proper

94
Q

What supplied blood to junction of greater curvature and greater omentum of stomach

A

Right and Left Gastro-Omental artery

95
Q

Where do the Right and Left Gastro-Omental artery arise

A

From Gastroduodenal Artery

96
Q

Minor blood supply to stomach is by

A

Posterior Gastric Artery

Short Gastric Artery

97
Q

Where do the Posterior and Short Gastric Artery arise

A

Splenic Artery

98
Q

What vessel supplies majority of blood to liver

A

Hepatic Portal Vein, 20% by Right and Left Hepatic Arter

99
Q

Peritoneal cavities related to liver

A

Hepatorenal and sub-phrenic recess

100
Q

Lowest part of peritoneal cavity when patient is supine

A

Hepatorenal recess

101
Q

What drains blood to the Hepatic Portal Vein

A

Splenic Vein (Foregut) and Superior Mesenteric Vein (Midgut). Inferior Mesenteric Vein (Hindgut) drains to the Splenic Vein to join Portal Vein

102
Q

What supplies blood to gallbladder

A

Cystic artery, branch of right Hepatic Artery (75%)

103
Q

What is the Cystohepatic triangle

A

Triangle of Calot, lines medially by Common Hepatic Duct, inferiorly by Cystic Duct and superiorly by inferior aspect of Liver. This is where the Cystic Artery lies, located during laparoscopic cholecystectomy

104
Q

Where is pain from Gallbladder felt

A

Foregut organ, T6-T9, Epigastric region

105
Q

What is Cholecystectomy

A

Surgical removal of Gallbladder

106
Q

What is the biliary tree

A

Right and left hepatic duct combine to form the common hepatic duct. This unites with the cystic duct to form the common bile duct.

107
Q

Where does the bile duct drain into

A

Bile duct along with pancreatic duct drains into the 2nd part of duodenum at the ampulla of vater

108
Q

Start and end of Duodenum

A

Starts at pyloric sphincter and end at duodenaljejunal flexure

109
Q

Is the duodenum intra or retroperitoneal

A

Retroperitonal, part of superior duodenum is intraperitoneal

110
Q

Hormones secreted into the blood at duodenum

A

Gastrin (G cells, release HCl from parietal cells) and CCK (release of bile and enzymes from pancreas)

111
Q

Where does pain from duodenum refer to

A

Epigastric region

112
Q

Parts of the duodenum

A

Superior, descending, horizontal and ascending

113
Q

Is the pancrease intra or retroperitoneal

A

Retroperitoneal

114
Q

Parts of pancreas

A

Head, neck, body and tail

115
Q

Functions of pancreas

A

Exocrine - Acinar cells (pancreatic enzymes into main pancreatic duct)
Endocrine - Islet of Langerhans (insulin and glucagon into bloodstream)

116
Q

Hepatopancreatic vater is also known as

A

Ampulla of vater

117
Q

Accessory pancreatic duct drains into

A

Minor duodenal papilla

118
Q

Sphincters at the biliary system

A

Bile duct and pancreatic duct sphincter, sphincter of Oddi (at ampulla of Vater)

119
Q

What is endoscopic retrograde cholangiopancreatography

A

Investigation used to study the biliary tree and pancreas and treat pathologies associated with it. A cannula is placed into major duodenal papilla and radio opague dye injected back into biliary tree. Radiographic images taken

120
Q

Obstruction of biliary tree causing jaundice

A

Gallstones, carcinomas of head of pancreas. This leads to bile back up to the liver. Overspill into the blood of its contents including bilirubin. These is post-hepatic jaundice

121
Q

Blood supply of duodenum and pancreas

A

Splenic artery from celiac trunk gives off the dorsal pancreatic artery. Gastroduodenal artery from common hepatic artery gives off superior pancreaticduodenal artery which anastomoses with inferior pancreaticduodenal artery arising from the superior mesenteric artery.

122
Q

Most common cause of pancreatic pain

A

Pancreatitis. A common cause of this is a gallstone blocking the ampulla causing backflow of bile into the pancreas. This leads to irritation and inflammation.

123
Q

Where does pain form pancreas radiate

A

Epigastric or umbilical region and also to the back

124
Q

What can advanced pancreatitis cause

A

Vascular haemorrhage leading to blood/fluid accumulation in retroperitoneal space.

125
Q

Grey-Turners sign vs Cullen’s sign

A

Bruising as a blue discoloration in the flanks is Grey-Turners sign whereas blue discoloration around the umbilicus via falciform ligament is Cullen’s sign

126
Q

Which parts of the duodenum are foregut

A

1st and 2nd part of duodenum

127
Q

Where does the Ileum end

A

Ileocecal junction

128
Q

Jejunum vs Ileum in wall

A

Jejunum is thicker and heavier, Ileum is thinner and lighter

129
Q

Jejunum vs Ileum in vascularity

A

Jejunum is more vascular, Ileum is less vascular

130
Q

Jejunum vs Ileum in mesenteric fat

A

Jejunum has lesser mesenteric fat, Ileum has more

131
Q

Jejunum vs Ileum in circular folds

A

Jejunum has large, tall and closely packed folds

Ileum has low and sparse folds

132
Q

Jejunum vs Ileum in lymphoid patches

A

Peyer’s patches present in Ileum

133
Q

Arterial blood to jejunum and ileum

A

Superior mesenteric artery drains to jejunal and ileal arteries

134
Q

Venous drainage from jejunum and ileum

A

Jejunal and ileal veins drain to superior mesenteric vein which drains to hepatic portal vein

135
Q

Route of superior mesenteric artery

A

Leaves the aorta at L1, posterior to head of pancreas and anterior to uncinate process of pancreas

136
Q

How is fat absorbed in the GI tract

A

Bile helps in the absorption of fats from GI tract lumen into enterocytes. Fats (within chylomicrons) then go into specialized lymphatic vessels called lacteals. They travel via thoracic duct (lymphatic system) to drain into the venous system at left venous angle

137
Q

Where do lymphatics lie in the abdomen

A 
Celiac (foregut organs)
Superior mesenteric (midgut)
Inferior mesenteric (hindgut)
Lumbar (kidneys, posterior abdominal wall, pelvis and lower limbs)
138
Q

What drains at the left venous angle

A

Thoracic duct

139
Q

What drains at the right venous angle

A

Right lymphatic duct

140
Q

Parts of large intestine from proximal to distal

A

Caecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, anus

141
Q

Functions of large intestine

A

Defence (commensal bacteria), absorption (H2O and electrolytes) and excretion (of formed stool)

142
Q

What are secondary retroperitoneal organs

A

Organs that were once suspended within the abdominal cavity by mesentery but migrated posterior to the peritoneum during embryogenesis

143
Q

Which parts of large intestine are intraperitoneal

A

Caecum, transverse colon, sigmoid colon

144
Q

What are paracolic gutters

A

Spaces between the colon and abdominal wall

145
Q

Significance of paracolic gutters

A

Site for collection of pus

146
Q

Distinguishing features of large intestine

A

Haustra - Small pouches caused by sacculation which give its segmented appearance
Teniae coli - Distinct longitudinal bands of smooth muscles from caecum to distal end of sigmoid colon
Omental appendices - Small pouches of peritoneum filled with fat along the colon, absent in rectum

147
Q

Where does the caecum and appendix lie

A

Right illiac fossa, contains the ileocaecal orifice and appendiceal orifice

148
Q

What is McBurney’s point on anterior abdominal wall

A

1/3 between umbilicus and ASIS, this presents with maximum tenderness in appendicitis

149
Q

What is the sigmoid colon at risk of

A

Sigmoid volvulus, sigmoid colon twists around itself resulting in bowel obstruction. This can lead to infarct

150
Q

Midline branches of abdominal aorta

A

Celiac trunk (foregut), Superior (midgut) and Inferior Mesenteric (hindgut) artery

151
Q

Abdominal aorta bifurcates into

A

Common illiacs which further bifurcates into internal and external iliacs

152
Q

Branches of superior mesenteric artery

A

Inferior pancreaticoduodenal, middle colic artery, right colic artery, ileocolic branches, jejunal and ileal arteries, appendicular,

153
Q

Compare jejunal and ileal arteries

A

Jejunal arteries - Longer vasa rectae, larger and fewer arterial arcades
Ileal arteries - Shorter vasa rectae, smaller and many arterial arcades

154
Q

Branches of inferior mesenteric artery

A

Left colic artery, sigmoid arteries, superior rectal artery

155
Q

What provides an arterial anastomoses between the superior and inferior mesenteric artery

A

Marginal artery of Drummond, between middle colic artery (SMA) and left colic artery (IMA)

156
Q

What supplies the rectum and anal canal

A

Superior rectal artery, branch of IMA

157
Q

Where does the hindgut extend to

A

Proximal half of anal canal (pectinate line)

158
Q

What supplies the rest of the GI tract after pectinate line

A

Internal illiac artery, middle and inferior rectal artery

159
Q

What drains the fore, mid and hindgut

A

Foregut - Splenic vein
Midgut - Superior mesenteric vein
Hindgut - Inferior mesenteric vein

160
Q

Portal systemic anastomesis

A

Distal end of oesophagus, skin around umbilicus and rectum/anal canal

161
Q

Drainage of distal end of oesophagus

A

Inferior part drains to hepatic portal vein

Superior part drains to azygous vein

162
Q

Drainage of skin around umbilicus

A

Para-umbilical vein to portal system via round ligament of liver
Epigastric vein drain to caval system (IVC)

163
Q

Drainage of rectum/anal canal

A

Rectum and superior anal canal drains to inferior mesenteric vein
Inferior part of GI tract drains to internal iliac veins

164
Q

What can portal hypertension lead to

A

Reversal of blood flow, large volume of blood flows to anastomotic areas causing them to become varicosed

165
Q

Clinical presentation of portal hypertension

A

Oesophageal varices - Dilated submucosal veins
Caput medusa - Dilated para-umbilical and epigastric vein
Rectal varices

166
Q

What can cause portal hypertension

A

Liver cirrhosis or tumour compressing hepatic portal vein

167
Q

Cause of haematemesis

A

Peptic ulcer in wall of stomach/duodenum that has eroded the mucosa and filled it with blood. (or)
Bleeding form oesophageal varice. Abnormally dilated veins have potential to rupture. These are formed often due to pathology in portal venous system

168
Q

Function of distal GI tract

A

Excrete stool

169
Q

What is faecal continence

A

Ability to control defecation

170
Q

Inferior part of pelvic cavity or pelvic floor is formed by

A

Levator ani muscles

171
Q

Openings in the pelvic floor

A

Anterior to posterior - Bladder, Uterus (females), Rectum

172
Q

What level does sigmoid colon become rectum

A

S3

173
Q

Where does the rectum become anal canal

A

At tip of coccyx prior to passing through the levator ani muscles

174
Q

Difference in location between rectum vs anus vs anal canal

A

Rectum is in the pelvis whereas the anus and anal canal are in the perineum

175
Q

Function of folds in rectal ampulla

A

Allows extension and prevents tearing while holding faecal matter

176
Q

What lies anterior to superior rectum

A

Rectouterine and rectovesical pouch

177
Q

What lies anterior to inferior rectum in males

A

Prostate gland

178
Q

What lies anterior to inferior rectum in females

A

Vagina and cervix

179
Q

Perineal roof is formed by

A

Levator ani muscles

180
Q

What muscles make up the levator ani muscles

A

Puborectalis (Medial), Pubococcygeus (Lateral), Iliococcygeus (Posterior) and Coccygeus (Tiny)

181
Q

What is the levator ani muscle tonically contracted

A

To support pelvic organs, reflexively contracts more during sneezing and coughing due to increase abdominal pressure

182
Q

What supplies the levator ani muscles

A

Nerves from sacral plexus (nerve to levator ani) and S2,3,4 (Pudendal nerve)

183
Q

What part of levator ani muscle acts as a functional sphincter

A

Puborectalis muscle, contraction decreases anorectal angle and maintains continence

184
Q

What type of muscle is puborectalis made up of

A

Skeletal muscle, it’s under voluntary control

185
Q

What are the anal sphincters made up fo

A

Internal - Smooth

External - Skeletal

186
Q

What part of external anal sphincter is continuous with puborectalis muscle

A

Superior part of sphincter

187
Q

Contraction of anal sphincters

A

Sympathetic nerves - Internal

Parasympathetic (pudendal) - External

188
Q

Which anal sphincter relaxes in response to distension of rectal ampulla

A

Internal anal sphincter

189
Q

Which anal sphincter contracts in response to distension of rectal ampulla

A

External anal sphincter

190
Q

Innervation of rectum/anal canal

A

Sympathetic fibres from T12-T2 travel to inferior mesenteric ganglia, synapse then travel around branches of inferior mesenteric artery. Inhibit peristalsis and contract internal anal sphincter
Parasympathetic fibres from S2-S4 via pelvic splanchnic nerves synapse in walls of rectum and inhibit internal anal sphincter, stimulating peristalsis.
Somatic motor - From pudendal nerve (S2-S4) and nerve to levator ani (S3,S4) contract external anal sphincter and puborectalis

191
Q

Route of pudendal nerve

A

S2,3,4 anterior rami, branch of sacral plexus. Supplies external anal sphincter. Exits pelvis via greater sciatic foramen. Enters perineum via lesser sciatic foramen. Branches to supply structures of perineum

192
Q

Where does the pudendal nerve exit pelvis

A

Greater sciatic foramen

193
Q

Where does the pudendal nerve enter perineum

A

Lesser sciatic foramen

194
Q

Plexus of pudendal nerve

A

Sacral plexus

195
Q

How can pregnancy lead to faecal incontinence

A

Tear of the perineum posteriorly can affect fibres of puborectalis or external anal sphincter. Branches of pudendal nerve could also be stretched and tear

196
Q

What is the pectinate line

A

The junction between the part of embryo that formed GI tract (endoderm) and part that formed skin (ectoderm)

197
Q

Differentiate above and below pectinate line for nerve supply, arterial supply, venous drainage, lymphatic drainage

A

Above vs Below
Nerve - Autonomic vs somatic via Pudendal nerve
Arterial supply - Inferior mesenteric vs internal iliac
Venous drainage - To Hepatic portal vein via IMV vs Caval system via internal iliac
Lymphatic drainage - Inferior mesenteric nodes (internal iliac nodes) vs Superficial inguinal nodes

198
Q

Lymphatic drainage of pelvis

A

Lymph vessels drain inferior pelvic structures via internal iliac and superior pelvic structures via external iliac. This drains into the common iliac which drains to the lumbar nodes. This eventually connects to the thoracic duct which drains into the left subclavian vein

199
Q

Where does the hindgut end

A

Proximal half of anal canal (above pectinate line)

200
Q

What artery supplies hindgut part of rectum

A

Superior rectal artery which arises from inferior mesenteric artery

201
Q

Which artery supplies remainder of GI tract, after hindgut

A

Middle and inferior rectal artery arising from internal iliac artery

202
Q

Venous drainage from hindgut part of rectal canal

A

Proximal half of rectal canal - Hindgut

This is drained by superior rectal canal into the inferior mesenteric vein to join portal venous system

203
Q

Venous drainage from rest of GI tract after hindgut

A

Middle and inferior rectal vein drains into the iliac vein which joins the systemic venous system

204
Q

What are rectal varice

A

Dilation of collateral veins between portal and systemic venous systems due to portal hypertension

205
Q

What are haemorrhoids

A

Prolapse of rectal venous varices due to increased pressure; due to chronic constipation, strain, pregnancy

206
Q

Which type of haemorrhoids are more painful and why

A

Internal haemorrhoids is less painful as they are above the pectinate line; visceral innervation compared to external which are somatic innervations.

207
Q

What is the ischioanal fossa

A

The ischioanal fossa lie on each side of the anal canal.

208
Q

What is present in the ischioanal fossa

A

Fat and loose connective tissue

209
Q

What can a fistula between the rectum and ischioanal fossa lead to

A

Faeces can collect in the ischioanal fossa causing an infection. This is known as ischioanal abscess

210
Q

What is palpated for in a rectal examination (PR)

A

Assess anal tone, effectiveness/strength of external anal sphincter. In male, palpate for prostate and females cervix anteriorly

211
Q

What is proctoscopy used for

A

To view the inside of the rectum

212
Q

What is sigmoidoscopy used for

A

To view the interior of sigmoid colon

213
Q

What is colonoscopy used for

A

To view the interior of colon

GI (32 decks)

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