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Flashcards in Anatomy and Imaging Deck (260):
1

Skeletal muscle in the GI tract is found in the (4)

mouth
pharynx
upper oeso
external anal sphincter

2

4 activities of the GI tract =

motility (mainly SM)
secretion
digestion
absorption

3

contains epithelial, exocrine and endocrine gland cells
lamina propria
muscularis mucosae

GI mucosa

4

4 layers of GI tract wall =

mucosa > submucosa > musularis externa > serosa

5

Regulates the SA and shape of mucosa layer in gut

muscularis mucosae

6

Lamina propria of gut wall contains:

capillaries
enteric NS
immune cells

7

made up of connective tissue, blood and lymph vessels, glands and nerve network

submucosa

8

regulates the absorptive and secretive functions of the submucosa

Meissner's/submucosal plexus

9

___ muscle then _____ plexus (regulates mechanical activity of the gut) then ____ muscle
In typical gut wall muscularis externa

circular
Myenteric/Auerbach's
longitudinal

10

Connective tissue layer of gut wall that secretes sticky fluid so gut slides over itself

serosa

11

Contraction of gut circular muscle causes ___

tube to narrow and lengthen

12

Contraction of gut longitudinal muscle causes ____

tube to shorten and fatten

13

3 bands of muscularis externa longitudinal muscle in colon

teniae coli

14

Slow wave electrical activity in the enteric NS is driven by ____

ICC pacemakers
Interstitial cells of Cajal

15

ICCs lie in :

between muscle layers of muscularis externa
in submucosa
few in SM cells

16

___ allow depolarisation and contraction in the gut to occur as a functional syncytium

gap junctions => single unit SM

17

Upstroke of slow wave electrical activity in the gut is caused by ___

voltage activated Ca2+ channels = Ca2+ influx

18

Downstroke of slow wave electrical activity in the gut is caused by ____

voltage and Ca2+ activated K+ channels = K+ efflux

19

ICC are regulated by _,_+_

enteric+autonomic nerves
hormones

20

The force of gut contraction is directly proportional to the ___ from ICC

number of APs produced

21

Determines the max. frequency, direction and velocity of gut contractions

Slow wave electrical activity - driven by ICCs

22

BER (basic electrical rhythm) is determined by:

slow wave electrical activity

23

BER in duodenum is greater/less than in ileum = food moves in ___ direction

greater
aboral

24

BER in proximal colon is greater/less than in the sigmoid colon = food moves in ___ direction

less
oral

25

neuronal, hormonal and mechanical stimuli increase the chance of slow waves getting to threshold by ____

increasing basal depolarisation by opening Ca2+ L channels

26

Plexus in gut that modulates epithelia and blood vessels=

Meissner's/submucosal

27

Plexus in gut that regulates motility and sphincters =

Myenteric/Auerbach's

28

Key transmitters in enteric NS =

ACh, substance P, NO + VIP - regulate peristalsis
5-HT

29

sensory neurones in the gut are __,_+___ receptors

thermo, chemo and mechano

30

Most abundant type of neuron in enteric NS
co-ordinate reflexes and motor programs

interneurones

31

motor neurones in the enteric NS supply the (4)

SM, secretory epithelium, endocrine glands + blood vessels

32

Vagus nerve supplies ___(4) in the gut with parasympathetics

oesophagus
stomach
small intestine
ascending colon
(synapses with ENS)

33

Supplies the descending and sigmoid colon with parasympathetics

pelvic nerves
S2-4 (synapses with ENS)

34

Excitatory effects of parasympathetics on GI tract (3)

Increase gastric, pancreatic and small int secretions
increase blood flow to gut
increase SM contraction

35

Inhibitory effects of parasympathetics on GI tract

relax some sphincters and the stomach

36

Pre/postganglionic autonomic fibres synapse with ENS
(answer for para and symp)

para = pre
symp = post (synapses first in superior cervical and prevertebral - celiac aand sup inf mesenteric - ganglia)

37

excitatory effects of sympathetics on GI tract

increase sphincter tone

38

inhibitory effects of sympathetics on GI tract

decrease motility, secretions and blood flow

39

Example of a local reflex in the GI tract

peristalsis

40

In local and short reflexes in the GI tract the sensory, inter and effector neurones are found in the

myenteric plexus in the muscularis externa

41

Example of a short reflex in the GI tract

intestino-intestinal inhibitory reflex

42

What happens in the intestino-intestinal inhibitory reflex?

local distension > (sensory neurone) > sympathetic pre-ganglion > (interneurone) > (effector neurone) > decreased muscle activity in adjacent areas

43

Example of a long reflex in the GI tract

gastroileal

44

What happens in the gastro-ileal reflex?

increased gastric activity > increased propulsion in terminal ileum

45

...> sensory neurone (outwith muscularis externa) > dorsal motor nucleus (of vagus in medulla oblongata) > interneurone > effector neurone > ...
occurs in which reflex?

Long reflex in GI tract eg. gastroileal

46

__+___ causes muscle layers in the gut to contract in peristalsis

ACh and substance P

47

__+___ cause muscle layers in the gut to relax in peristalsis

NO and VIP

48

In the gut segment in front of food in peristalsis
longitudinal SM ___ and circular SM ___

In front =
longitudinal contracts
circular relaxes

49

In the gut segment behind food in peristalsis
longitudinal SM ___ and circular SM ___

Behind =
longitudinal relaxes
circular contracts

50

Rhythmic circular contraction in the small intestine =
function =
occur in __ state

segmentation
mixes food
fed state

51

rhythmic circular contraction in large intestine that mixes food =

haustration

52

powerful contraction that moves faeces into the rectum and occurs a couple x per day

colonic mass movement

53

causes a powerful contraction to move food from the stomach to the terminal ileum

MMC - migrating motor complex

54

tonic contractions occur in organs with ___ function
eg. ___+___ = __ pressure
and in sphincters = ___ pressure

storage = gallbladder and stomach = low P
sphincters = high P

55

Two skeletal sphincters in GI tract

UOS and external anal

56

Pressure upstream/downstream of a sphincter ___ it

up = opens
down = shuts

57

UOS relaxes in ___
closes in ___

open = swallowing
closes = inspiration

58

LOS relaxes in ___
closes in ___

open in food>stomach
closes to prevent reflux

59

Pyloric sphincter regulates ___ and prevents ___

gastric emptying
prevents duodenal reflux

60

Muscle(s) that opens the mouth

lateral pterygoid

61

muscle(s) that close the mouth

medial pterygoid, masseter and temporalis

62

deglutition =

swallowing

63

1st/Voluntary/___ phase of deglutition:
___ receptors are stimulated when bolus reaches oropharynx
> afferents via ____ > __+___ > efferents ___ >

oral
mechanoreceptors
CN IX and X
pons and medulla
CN 7, 9, 10, 11
skeletal muscles of pharynx and larynx

64

2nd/pharyngeal phase of deglutition:
soft palate ___ and post. pharynx wall ___ to separate naso and oropharynx
ventilation is ___
___ muscles close the glottis and raise the ___
Sup. and middle pharyngeal ____
bolus moves ___ enters ___

soft palate rises
post. pharynx wall constricts
vent = inhibited
laryngeal muscles raise larynx
pharyngeal constrictors constrict
epiglottis -> oesopahgus
ventilation resumes

65

3rd/Oesophageal phase of deglutition lasts -

4-10 seconds

66

3rd/Oeso phase of deglutition:
___+___ > CNX -> ____ + ____

pons and medulla
close UOS and cause primary peristaltic wave

67

If bolus is lodged in oesophagus ____ receptors cause ___ and increased ___

local pressure receptors =
2ndry more powerful peristaltic wave and increased saliva production

68

Parotid gland lies:

anterior to ear and below zygomatic arch

69

The parotid duct/ _____ enters the mouth opposite the ____

duct of Stensen
2nd maxillary molar teeth

70

Parotid gland makes up ___% of salivary production

25%

71

Parotid gland is innervated by ___

CN IX and sympathetic plexus

72

___ cells in the Parotid gland secrete and ___ solution

serous cells =
watery α-amylase rich

73

Submandibular salivary glands lie ___

medial to body of the mandible

74

the submandibular salivary duct/____ enters mouth via the ___ at ____

duct of Wharten
via sublingual caruncula at the lingual frenulum (under tongue)

75

Submandibular glands make up __% of saliva secretion

70%

76

Submandibular glands have ___ cells
There secretion is more/less viscous than parotids

mucous and serous cells
more

77

Submandibular salivary glands are innervated by :

CN 7 and sympathetic plexus

78

Sublingual salivary glands lie ___

medial to submandibular glands

79

Sublingual salivary duct/___ -> ___ duct and connects with duct of Wharten at the ___

ductus of Rivinus
common Bartholin
sublingual caruncula

80

Sublingual glands make up __% of saliva secretions

5%

81

Sublingual glands have ___ cells = a ___ solution

mucous
mucus rich solution

82

Sublingual glands are innervated by ___

CN 7

83

Salivary glands are complex endo/exocrine glands.
Have an external ___
fibrous ___ between lobes and lobules
lobules are composed of ___

EXOcrine
external CAPSULE
fibrous SEPTA
lobules composed of SALIVONS

84

3 main parts of a salivon =

secretory acinus
intercalated duct
striated duct

85

Basic structure of secretory acinus in salivon

pyramiddal acinar cells around a central lumen

86

Serous acinar cells in salivons secrete ___ from ___ secretory granules

watery α-amylase rich secretion
small dense

87

Mucous acinar cells in salivons secrete ___ from ___ granules

mucus
large, pale

88

Serous and mucous acinar cells in salivons are surrounded by ___ which ___

myoepithelial cells
squeeze saliva into ducts

89

_____ at terminal end of secretory acinus in salivons secrete lysozymes

Serous demilunes

90

Intercalated ducts in salivons are made of ___ epithelium

cuboidal

91

Striated ducts in salivons are ___ epithelium with lots of ___ for active transport to modify saliva
combine to form __ and then ___

columnar epithelium with lots of mitochondria
interlobular > excretory ducts

92

attachments of the masseter muscle
(closes mouth)

angle of mandible
zygomatic arch

93

attachments of the temporalis muscle
(closes mouth)

coronoid process of mandible
temporal fossa

94

attachments of the medial pterygoid
(closes mouth)

medial side angle of mandible
pterygoid plates of the sphenoid

95

attachments of the lateral pterygoid
(opens mouth)

condyle of mandible
pterygoid plates of the sphenoid

96

the muscles that open and close the mouth are supplied by ____ nerve

mandibular CNV division
CNV3

97

course of CNV3
attaches to pons -> inferior edge of ____ between post.+middle ____ > ____ in sphenoid bone > structures

pons >
tentorium cerebelli ; cranial fossa >
foramen ovale

98

provides sensation to anterior 2/3 of tongue
(special and general)

general = CNV3
special = CNVII

99

provides sensation to posterior 1/3 of tongue
(special and general)

general and special = CNIX

100

Provides sensation to the superior 1/2 of oral cavity
(gingivae and palate)

general = CNV2
(Vert2go - vertigo=high part)

101

Provides sensation to the inferior 1/2 of oral cavity
(gingivae and floor)

general = CNV3

102

sensory nerves of gag reflex =
respond to ___

CNIX
touch to posterior wall of oral cavity

103

motor nerves of gag reflex =
cause ___

CNIX and X
pharynx to constrict

104

in endoscopy local anaesthetic spray blocks nerves:

CN V2, V3, VII, IX
(5, 7, 9)

105

Course of CNV2:
__ > inf. edge of ____ between post. and middle ____> ____ in sphenoid > structures

pons
tentorium cerebelli ; cranial fossa
foramen rotundum

106

CN__ is the only nerve to attach directly to the pons

CNV

107

Course of CNVII/7:
junction between__+__>____ in posterior ___> in temporal bone ____ to _____ (most fibres) OR ___ (over tympanic membrane > + lingual branch > tongue and submandibular gland)

pons + medulla
internal acoustic meatus ; cranial fossa
internal acoustic meatus to stylomastoid foramen
OR chorda tympani

108

CN VII joins with ____ branch of CN_ to supply __ to the anterior tongue and parasympathetics(____) to ___ salivary glands

lingual branch of V3 ; taste
secretomotor to submandibular

109

CNVII has __,__,__+__ nerve fibres

parasympathetic
special sensory
sensory
motor

110

The CNVII fibres that pass out of the stylomastoid foramen supply the____

muscles of facial expression

111

Course of CN IX/9:
___ > __ in posterior ___ between ___+___bone> posterior ___, palate, posterior ___ wall and parasympathetics to the ___

medulla>
jugular foramen ; posterior cranial fossa ; temporal and occipital bone>
post. tongue, post. oropharynx wall , parasymp to parotids

112

CN IX has ____(5) fibres

special sensory
sensory
motor
visceral afferent
parasympathetic

113

4 extrinsic muscles of the tongue =

palatoglossus
styloglossus
hyoglossus
genioglossus

114

palatoglossus attaches to ___ and the tongue

palatine bone

115

styloglossus attaches to ___ and the tongue

styloid process of temporal bone

116

hyoglossus attaches to ___ and the tongue

hyoid bone

117

genioglossus attaches to ___ and the tongue

genial tube on the mandible

118

There are ___ intrinsic muscles of the tongue

4 intrinsic muscles of the tongue

119

All tongue muscles (except _____) are supplied by CN___

CN XII - hypoglossal nerve
except palatoglossus = CNX

120

palatoglossus is supplied by CN ___

CNX - vagus

121

The course fo CNXII (12):
___ > ____ in posterior ___ >____ at anterior wall of ___ in ___ bone > descends lateral to ____ > level of __ bone and supplies ___

medulla >
hypoglossal canal in posterior cranial fossa
hypoglossal canal at ant. wall of foramen magnum in occipital bone
lateral to carotid sheath
hyoid bone
tongue

122

External layer of the pharynx = ___muscles
superior, medial and inferior layers ___
involuntary/voluntary muscles

constrictor/circular
overlap
voluntary

123

External circular muscles of pharynx are innervated by ___
muscles insert onto midline ___

CN X
midline raphe

124

The UOS / _____ muscle is at __ level and marks the boundary between _+_ and __+__

cricopharyngeus muscle
C6
pharynx>oeso
larynx>trachea

125

The internal muscles of the pharynx (4) are ___ innervated by ___/___
Function =_+_

longitudinal muscles
CNX - 3 muscles
CNIX - sylopharyngeus
contract to shorten - elevates pharynx
close over laryngeal inlet - elevates larynx

126

the oesophageal plexus has __+___ fibres that supply the ___ NS and alters the rate of ___

para(CNX) and symp
enteric NS
para increases + symp decreases = peristalsis

127

Oesophageal plexus stops at ___

cardia of the stomach

128

All of the muscles involved in the initial stage of swallowing (until the oeso) are ___ and supplied by __

skeletal
cranial nerves

129

Normal anatomical indents in oesophagus shown in barium swallow =

cervical - C6 cricopharyngeus
2x thoracic - aortic arch and L bronchus
diaphragmatic - diaphragm and LOS

130

LOS is a ____ sphincter and lies superior to ___
which is an abrupt mucosal change = ____

physiological sphincter
GOJ
Z-line

131

Indent in lesser curvature in stomach =

incisura angularis

132

Longest > shortest part of small intestine

ileum (4m)
jejunum (3m)
duodenum (short)

133

Foregut organs =

oeso-> mid duodenum + liver, gallbladder, spleen and 1/2 pancreas

134

Midgut organs =

mid duodenum to 2/3rds of transverse colon
1/2 pancreas

135

Hindgut organs =

distal 1/3 of transverse colon -> prox. 1/2 anal canal

136

4 lines that split the 9 regions of the gut =

mid clavicular x2
trans-tubercular
subcostal

137

Thin, transparent, semi-permeable, serous membrane =

peritoneum

138

Liver is a ___peritoneal organ = __ movement

intraperitoneal
little movement

139

double layers of mesentery =

condensations

140

lesser omentum is from __ to ___

liver to stomach

141

greater omentum has __ layers of mesentery and hangs from ___

4
stomach

142

free edge of lesser omentum contains the ___

portal triad

143

greater and lesser omentum communicate via the ____

omentum foramen

144

Pericentesis for ascites:
needle is inserted___ to avoid ___

lateral to rectus sheath
avoids inferior epigastric artery behind the rectus abdominus

145

inferior epigastric artery branches off the ___, __ to deep inguinal ring

external iliacs
medial to deep inguinal ring

146

Visceral peritoneum and the abdo organs are innervated by

enteric NS and autonomic NS

147

Parietal peritoneum and body wall are innervateed by

somatic sensory and motor
sympathetic NS

148

Sympathetic nerves to abdomen leave via ___ > enter symp chain > ______ nerves > synapse at prevertebral ganglia ____) > postsynaptic nerves > ___ plexus where combine with para and visceral afferents ->

T5-L2
abdomino-pelvic splanchnic nerves
anterior to aorta - celiac, aortico-renal and sup+inf mesenteric ganglia
periarterial plexus
SM and glands of organs

149

Adrenal glands are supplied by sympathetic nerves from __ which become ____ nerves -> periarterial plexus > synapse directly onto adrenals

T10-L2
abdomino-pelvic splanchnic nerves

150

Parasympathetic supply to gut organs up until distal end of transverse colon =

CNX

151

Parasympathetic supply to descending colon> anal canal =

pelvic splanchnic nerves (S2,3 and 4)

152

Pain in foregut is felt in ___ region

epigastric

153

Pain in midgut is felt in ___ region

umbilical

154

Pain in hindgut is felt in ___ region

pubic

155

Visceral afferents from foregut enter spinal cord at ____

T6-9

156

Visceral afferents from midgut enter spinal cord at ____

T8-12

157

Visceral afferents from hindgut enter spinal cord at ____

T10-L2

158

the 7th-11th intercostal nerves extend to become the ___ nerves and travel between ____+___
supply __

thoracoabdominal nerves
internal oblique and transversus abdominis
body wall

159

T12 anterior rami becomes ___ to supply

subcostal nerve
body wall

160

iliohypogastric nerve comes from __

half of L1 anterior ramus

161

ilioinguinal nerve comes from ___

half of L1 anterior ramus

162

Body wall nerves = (4)

thoracoabdominals
subcostal
iliohypogastric
ilioinguinal

163

Pancreatic pain is felt __ +___

epigastric
upper back

164

liver and gallbladder pain are felt

RUQ
back RUQ
right shoulder

165

Icterus =
caused by

jaundice
increased bilirubin in the blood

166

Portal triad =

hepatic artery
HPV
common bile duct
(+ nerves and lymphatics)

167

3 midline anterior branches of abdominal aorta
superior -> inferior

celiac
superior mesenteric
inferior mesenteric

168

Celiac trunk arises at __ level

T12

169

Celiac trunk trifurcates into

hepatic artery
splenic artery
L gastric artery

170

Runs a tortuous course over the top of the pancreas

splenic artery

171

Spleen is __peritoneal
protected by ribs ___

intraperitoneal
ribs 9-11

172

Hepatic artery branches into __+___+_ ->

R and L hepatic
R gastric (anastamoses with L gastric)
gastroduodenal ->superior pancreatico-duodenal + R-gastric omental

173

Branch of splenic artery that supplies greater curvature of the stomach
anastamoses w. ___

L gastro-omental artery
(anastamoses with R. gastric-omental from hepatic artery)

174

Ribs ___ protect the liver

Ribs 7-11

175

4 anatomical segments of liver =
_ functional segments

right, left, caudate (superior), quadrate (next to gallbladder)
8

176

Posterior recesses of peritoneal cavity
both lie within the ___ omentum

hepatorenal (Morrison's)
subphrenic
greater omentum

177

Ligaments of the liver

coronary ligaments (attach to diaphragm)
falciform ligament ( splits L+R lobe and attach to ant. abdo. wall)
ligamentum teres/round ligament (to umbilicus)

178

The ___ artery supplies the gallbladder
In 75% of people branches off of ___
In 25% of people branches off of __

cystic
R hepatic 75%
L hepatic/hepatic/celiac 25%

179

Biliary tree =
descends posterior to ___

R+L hepatic > common hepatic
+ cystic duct > CBD
first part of duodenum and pancreas

180

CBD joins pancreatic duct at ___ which leads to ___ and drains into the ___

the ampulla of Vater
major duodenal papilla
2nd part of duodenum

181

Post-hepatic causes of jaundice are due to ___
eg.s =

bile backflow into liver and blood
gallstones, pancreatic cancer, cholangitis, pancreatitis

182

Pre-hepatic causes of jaundice are due to ___
eg.s =

increased haemolysis of RBCs
malaria, sickle cell, AI

183

Hepatic causes of jaundice cause an increase in ____ bilirubin
eg.s =

unconjugated+/conjugated
cirrhosis, hepatitis, drugs, liver ca, AI, Gilbert's

184

5 parts of pancreas =

uncinate process
head
neck
body
tail

185

Pancreas is at level of ___

L1-2

186

Nerve supply for pancreas
para=
symp=
+___

para = vagus
symp = abdomino-pelvic splanchnic nerves
visceral afferents

187

blood supply to pancreas

pancreatic arteries off of splenic artery (mainly)
superior pancreaticoduodenal off of gastroduodenal
inferior pancreaticoduodenal off of superior mesenteric

188

What parts of duodenum are foregut?

1st and 2nd

189

1st/___ part of duodenum/____
__ in length
Is ___peritoneal

superior
duodenal cap
2cm
intraperitoneal

190

Which parts of duodenum are intra and retroperitoneal

1st = intraperitoneal
2,3,4th = retroperitoneal

191

Duodenum:
2nd part=
3rd part=
4th part=

2=descending
3=horizontal
4=ascending

192

Blood supply to duodenum =

superior and inferior pancreaticoduodenal arteries

193

Beginning of the jejunum
is ___ degrees

duodenaljejunal flexure
90 degrees

194

jejunum is ___peritoneal
the mucosa is ___ folded
folds =

intraperitoneal
highly
plicae circularis

195

blood supply and drainage to jejunum

superior mesenteric > jejunal arteries (long loops)
jejunal veins>sup mes

196

Ileum is ___peritoneal
Has __ folds+ muscle than jejunum
Absorbs ___+__

intraperitoneal
less
bile and B12

197

Blood supply and drainage to ileum

sup mes > ileal arteries - short loops
ileal vein > sup mes

198

Fat absorbed in gut enters blood via the ____

left venous angle

199

Lymph nodes that drain:
foregut:
midgut:
hindgut
kidneys, post abdo. wall, pelvis, lower limbs

foregut=celiac nodes
midgut=superior mesenteric nodes
hindgut = inferior mesenteric nodes
kidneys etc. = lumbar nodes

200

Parts of colon that are 2ndry retroperitoneal

ascending and decending = less mobile

201

Parts of colon that are intraperitoneal and so are mobile

caecum
transverse (very mobile)
sigmoid

202

lateral edge of asc + desc colon and abdominal wall=__
is part of the ___

paracolic gutters
greater sac of the peritoneal cavity

203

teniae coli are present on the colon until the ___

sigmorectal junction

204

64% of the time the appendix lies ___

retrocaecal

205

Appendix lies at ___ point, max area of pain in appendicits, which =

McBurney's
1/3 of the way between ASIS and umbilicus

206

Most likely part of colon to form a volvulus

sigmoid

207

Abdominal aorta lies to the L/R of the IVC
lateral branches and final bifurcation sup to inf =

L
renal
gonadal
body wall (posterolateral)
common iliac

208

internal iliac artery supplies the ___

pelvic organs

209

external iliac becomes the femoral artery after ___

after going behind the inguinal ligament

210

Branches off of the superior mesenteric artery superior to inferior

inferior pancreaticoduodenal
middle colic (transverse)
right colic (ascending)
ileocolic -> appendicular, jejunal and ileal

211

middle colic branch of sup mes artery supplies

transverse colon

212

right colic branch off of sup mes artery supplies

ascending colon

213

inferior mesenteric artery branches superior to inferior

left colic - descending
sigmoid colic
superior rectal (supplies until pectinate line)

214

The distal anal canal starts at the ___ and is supplied from the ___ artery

pectinate line
internal iliac -> middle and inferior rectal arteries (slightly anastamose with sup. rectal artery

215

anastamosis of the SMA and IMA is predominantly by 1 artery called

marginal artery of Drummond

216

Superior part of oeso usually drains to ___ and distal end drains to ____
Is an anastamosis between systemic and portal systems

sup = azygous
inf = HPV

217

rectum becomes anal canal just before passing through ___ + anterior to ___

levator ani
tip of coccyx

218

anal canal and anus lie in pelvic cavity/perineum

perineum

219

at __ level sigmoid becomes rectum

S3

220

rectal ampulla lies superior to ___

levator ani

221

pelvic diaphragm =

levator ani and fascial covering

222

3 main levator ani muscles =

iliococcygeus
pubococcygeus
puborectalis
all = skeletal and voluntary

223

levator ani muscle that slings around rectum and contracts to lower anorectal angle
important in continence

puborectalis

224

Nerves to levator ani =
cause its and internal anal sphincter contraction

nerve to levator ani mostly - S3+4
pudendal - S2, 3 and 4

225

internal anal sphincter site =
contraction is inhibited by ___ when the ampulla is distended

superior 2/3rds of anal canal
parasympathetics

226

external anal sphincter site =
is continuous superiorly with ___
contraction is stimulated by ___ nerve

inferior 2/3rds of anal canal
puborectalis muscle
pudendal nerve

227

Sympathetic nerves that cause internal anal sphincter to contract and inhibits peristalsis

T12-L2

228

Visceral afferents go to ___ with ___
sense - stretch and ischaemia of rectum and anal canal

S2-4
parasympathetics

229

paraympathetic supply to rectum and anal sphincter is from ___
relaxes internal anal sphincter

S2-4

230

Pudendal nerve comes from a branch of the ____
exits pelvis at ___ and enters via ___ to supply perineum

sacral plexus
greater sciatic foramen
lesser sciatic foramen

231

Embryologically pectinate marks line between __derm and ___ derm derived parts

endoderm and ectoderm

232

nerve, lymphatics, vein and artery for above pectinate line

autonomic NS
IMA
sup. rectal vein >IMV->HPV
internal iliac nodes > inf mes nodes

233

nerve, lymphatics, vein and artery for below pectinate line

somatic and pudendal nerves
internal iliac artery
middle and inf rectal vein >int iliac vein -> systemic veins
superficial inguinal nodes

234

epithelium above and below pectinate line =

above = columnar
below = non keratinised stratified squamous

235

inferior pelvic structures drain to ____ nodes

internal iliac nodes

236

superior pelvic structures and lower limb drain to ___ nodes

external iliac nodes

237

internal and external iliac nodes drain to ___ nodes to ___ nodes

common iliac nodes
lumbar nodes

238

Haemorrhoids are caused by ___
defintion =

raised P
prolapses of rectal venous plexuses

239

Red horseshoe around anus =

ischioanal abcess

240

ischioanal fossae contains
R and L communicate ____

fat and loose connective tissue
posteriorly

241

US is good for imaging ___ organs and free ___

solid eg. biliary tree and urinary tract
fluid

242

MRI is good for imaging ___ and has no ___

soft tissues
no radiation

243

Parts of pancreas and duodenum that lie in RUQ

1,2,3rd parts of duodenum
head of pancreas

244

Duodenal jejunum junction is also called ___

ligament of Treitz

245

scintigraphy =

production of imaging using radioactive compounds to = 2D image

246

cytochemisty =

identifying biochemistry of cell
eg. Perl's stain for Fe, for enzymes, for leukaemia

247

cytogenetic analysis =

study of chromosomes and their abnormalities

248

immunophenotyping =

investigate the pattern of antigen expression on/in cells through a panel of antibodies
can produce a protein expression profile unique to different cell types eg. T cells

249

First line imaging for biliary colic/cholycystitis=
and further clarification=

US
MRCP/ERCP

250

Pancreatitis firstline imaging =
imaging to show complications after 1wk =

US
CT/others

251

Firstline imaging for perforation =
__ shows source and complications

Erect CXR - subphrenic gas
CT

252

1st line imaging for appendicitis

US

253

Imaging for diverticulitis to see inflammatory change and associted complications =

CT

254

Imaging for distended abdomen (suspected that it's due to bowel gas)

AXR (shows if obstruction/ileus)
CT

255

Imaging for distended abdomen (suspect fluid)

US

256

1st line investigation for haematemesis/lower GI bleed
complements it =

endoscopy
Radiology - CT with IV contrst +/ angiography

257

1st line investigation for dysphagia =
___ gives you functional and anatomical/pathological info

endoscopy
barium/contrast studies

258

Change in bowel habit examination/imaging =

PR
CT colonography if want R colon information
if IBD considered = endoscopy

259

typical appearance of liver met.s on US =

target

260

1st line investigation for jaundice=
biliary cause =>
liver lesions =>
nodular and course contours of liver=>

US ->
M/ERCP
CT (cancer)
US guided biopsy (cirrhosis)