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Medicine Unit 3 > Anatomy: Midgut > Flashcards

Anatomy: Midgut Flashcards

1
Q

location of the small intestine

A

gastrointestinal tract
extends from pylorus to ileocaecal junction to the large intestine at the ileocaecal valve

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2
Q

3 parts of the small intestine

A

duodenum
jejunum
ileum

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3
Q

general overview duodenum

A

most proximal portion
derived from duodenum digitorum= twelve fingers length
runs from pylorus to the duodenojejunal junction

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4
Q

what are the 4 parts of the duodenum

A

D1= superior
D2=descending
D3=inferior
D4=ascending

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5
Q

superior D1

A

first section, spinal level L1
known as the cap
ascends upwards from pylorus of the stomach
connected to liver by the hepatoduodenal ligament
most common site for duodenal ulceration
3cm covered anteriorly and posteriorly by visceral peritoneum and remainder is retroperitoneal

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6
Q

descending D2

A

L1-L3
curves inferiorly around head of the pancreas
lies posteriorly to the transverse colon and anterior to the right kidney
internally marked by the major duodenal papilla

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7
Q

what is the major duodenal papilla

A

opening at which bile and pancreatic secretions enter from the ampulla of Vater (hepatopancreatic ampulla)

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8
Q

Inferior D3

A

L3
travels laterally to the left
crosses over the inferior vena cava and aorta
located inferiorly to the pancreas
posteriorly to the superior mesenteric artery and vein

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9
Q

Ascending

A

L3-L2
after duodenum crosses aorta it ascends and curves anteriorly to join the jejunum at the duodenojejunal flexure

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10
Q

duodenojejunal flexure

A

located here is a muscle called the suspensory muscle of the duodenum
contraction of the muscle widens the angle of the flexure
aids movement of the intestinal contents into the jejunum

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11
Q

duodenal ulcers

A

most likely to occur in the superior portion
common causes are helicobacter pylori infection and chronic NSAID therapy
perforation may be complicated by:
-inflammation of the peritoneum (peritonitis): damages surrounding viscera
-erosion of the gasproduodenal artery: causes haemorrhage and potential hypovolaemia shock

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12
Q

contrasting the jejunum and the ileum to the duodenum

A

they’re intraperitoneal

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13
Q

what attaches the jejunum and ileum to the posterior abdominal wall

A

mesentery

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14
Q

jejunum

A

begins are the duodenojejunal flexure
ileum ends at ileocaecal junction

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15
Q

what occurs at the ileocaecal junction

A

the ileum invaginate into the cecum to form the ileocecal valve
can prevent reflux of material back into the ileum

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16
Q

characteristic features of the jejunum

A

located in the upper left quadrant
thick intestinal wall
longer vasa recta (straight arteries)
less arcades (arterial loops)
red in colour

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17
Q

characteristic features of the ileum

A

located in the lower right quadrant
thin intestinal wall
shorter vasa recta
more arcades
pink colour

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18
Q

arterial supply of the duodenum

A

proximal to the major duodenal papilla: supplied by the gastroduodenal artery
distal to the major duodenal papilla: supplied by the inferior pancreaticoduodenal artery

marks the change form foregut to midgut
veins of duodenum follow major arteries and drain into hepatic portal vein

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19
Q

lymphatic drainage of the duodenum

A

pancreatoduodenal
superior mesenteric nodes

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20
Q

arterial and venous supply of jejunum and ileum

A

from the superior mesenteric artery
venous drainage is from the superior mesenteric vein

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21
Q

lymphatic drainage of the jejunum and ileum

A

superior mesenteric nodes

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22
Q

where is the cecum located

A

most proximal part of the large intestine
located between the ileum and ascending colon

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23
Q

when can the cecum be palpated

A

if enlarged due to faeces, inflammation or malignancy

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24
Q

structure of the cecum

A

continuous with the ascending colon
is intraperitoneal
has a variable mesentery

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25
Q

ileocecal valve function

A

prevents reflux of large bowel contents into the ileum during peristalsis
thought to function passively rather than a defined muscular sphincter

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26
Q

cecum arterial supply

A

ileocolic artery- branch of the superior mesenteric
divides into anterior and posterior cecal arteries

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27
Q

cecum venous supply

A

ileocolic vein
then empties into the superior mesenteric plexus

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28
Q

lymphatic drainage of the cecum

A

drains into the ileocolic lymph nodes

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29
Q

what is the appendix

A

narrow blind-ended tube
attached to the posteromedial end of the cecum
large amount of lymphoid tissue
no vital functions

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30
Q

what is the appendix supported by

A

the mesoappendix
fold of mesentery which suspends the appendix from the terminal ileum
position of the free end of the appendix is highly variable and categorised into 7 main locations depending on relationship to the ileum, caecum or pelvis

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31
Q

what is the most common position of the appendix

A

retrocecal

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32
Q

positions of the appendix

A

pre-ileac
post-ileac
sub-ileal
pelvic
subecal
paracecal
retrocecal

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33
Q

pre-ileal

A

anterior to the terminal ileum
1 or 2 o clock

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34
Q

post-ileal

A

posterior to the terminal ileum
1 or 2 o clock

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35
Q

sub-ileal

A

parallel with the terminal ileum
3 o clock

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36
Q

pelvic

A

descending over the pelvic brim
5 o clock

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37
Q

subcecal

A

below the cecum
6 o clock

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38
Q

paracecal

A

alongside the lateral border of the cecum
10 o clock

39
Q

retrocecal

A

behind the cecum
11 o clock

40
Q

arterial supply to the appendix

A

from the appendicular artery

41
Q

venous drainage of the appendix

A

via the corresponding appendicular vein

42
Q

where are the arteries and veins associated with the appendix located

A

in the mesoappendix

43
Q

innveration of the appendix

A

ileocolic branch of the superior mesenteric plexus

44
Q

colon general information

A

distal part of the gastrointestinal tract
extends from the cecum to the anal canal
receives digested food from the small intestine, absorbs water and electrolytes to form faces

45
Q

4 parts of the large intestine

A

ascending
transverse
descending
sigmoid

46
Q

ascending colon

A

retroperitoneal
ascends superiorly from the cecum
meets right lobe of the liver to form the colic/hepatic flexure

47
Q

transverse colon

A

extends from the right colic flexure to the spleen
turns inferiorly to form the left colic/splenic flexure
attached to the diaphragm by the phrenicocolic ligament
intraperitoneal and enclosed by transverse mesocolon

48
Q

descending colon

A

after left colic flexure moves inferiorly towards the pelvis
retroperitoneal in most individuals
located anteriorly to the left kidney
passes over its lateral border
turns medially and becomes sigmoid

49
Q

sigmoid

A

40cm long
left lower quadrant
left iliac fossa to level of S3 vertebrae
attached to posterior pelvic wall by mesentery: sigmoid mesocolon
mobile due to length of the mesentery

50
Q

parabolic gutters

A

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

51
Q

anatomical structure of the large intestine

A

attached to the surface of the large intestine are omental appendices
runs longitudinally along surface of the large bowel are 3 strips of muscle teniae coli
teniae coli contract to shorten the wall of the bowel, produces sacculations called haustra
wider diameter Than the small intestine
features cease at the rebtosigmoid junction

52
Q

what are omental appendices

A

small pouches of peritoneum, filled with fat

53
Q

rectosigmoid junction

A

where the smooth muscle of the teniae coli broken to form a complete layer within the rectum

54
Q

teniae coli

A

mesocolic
free
omental coli

55
Q

structures anterior and posterior to the ascending colon

A

anterior: small intestine, greater momentum, anterior abdominal wall
posterior: iliacus and quadrates lumborum, right kidney, iliohypogastric and ilioinguinal nerves

56
Q

transverse colon structures anterior and posterior

A

anterior: greater omentum, anterior abdominal wall
posterior: duodenum, head of pancreas, jejunum and ileum

57
Q

descending colon structures anterior and posterior

A

anterior: small intestine, greater omentum, anterior abdominal wall
posterior: iliacus and quadratus lumborum, left kidney, iliohypogastric and ilioinguinal nerves

58
Q

sigmoid colon structures anterior and posterior

A

anterior: urinary bladder, uterus and upper vagina
posterior: rectum,sacrum,ileum

59
Q

general rule midgut arterial supply

A

supplied by the superior mesenteric artery

60
Q

general rule hiindgut arterial supply

A

by the inferior mesenteric artery

61
Q

ascending colon arterial supply

A

from ileocolic and right colic arteries

ileocolic arises the anterior cecal, posterior cecal and colic branches which also supply

62
Q

transverse colon arterial supply

A

right colic artery, from superior mesenteric
middle colic artery, from superior mesenteric
left colic artery, from inferior mesenteric

63
Q

descending colon arterial supply q

A

left colic artery

64
Q

sigmoid colon arterial supply

A

sigmoid arteries

65
Q

venous drainage of the ascending colon

A

ileocolic and right colic veins
empty into the superior mesenteric

66
Q

venous drainage of the transverse colon

A

middle colic vein
empties into the superior mesenteric

67
Q

venous drainage of the descending colon

A

left colic vein
drains into the inferior mesenteric

68
Q

venous drainage of the sigmoid colon

A

drained by the sigmoid veins into the inferior mesenteric

69
Q

where do the superior and inferior mesenteric veins empty into

A

the hepatic portal vein

70
Q

innervation of the midgut-derived structures

A

ascending colon and proximal 2/3 of the transverse
receive their sympathetic, parasympathetic and sensory supply via nerves from the superior mesenteric plexus

71
Q

innervation of the hangout-dervied structures

A

distal 1/3 of the transverse colon, descending colon and sigmoid colon
receive from the inferior mesenteric plexus
parasympathetic: pelvic splanchnic nerves
sympathetic: lumbar splanchnic

72
Q

functions of the mesentery in the abdomen

A

suspends the small and large intestine from the posterior abdominal wall, allows slight movement
provides a conduit for blood vessels, nerves and lymphatic vessels
postulated to play a pathological role in inflammatory disease such as crohns

73
Q

how is the mesentery formed

A

double layered fold of peritoneum

74
Q

root of the mesentery

A

point where the mesentery attaches to the posterior abdominal wall
bare area
root is long and narrow and has an oblique orientation
left side of the L2 vertebra to the right sacroiliac junction

75
Q

6 flexures in the gastrointestinal tract

A

duodenaljejunal
ileocaecal
hepatic
splenic
those between descending and sigmoid colon
and between the sigmoid and the rectum

76
Q

mesentery of the small intestine

A

connects the loops of jejunum and ileum to the posterior abdominal wall and is a mobile structure

77
Q

right mesocolon

A

flattened against the posterior abdominal wall

78
Q

transverse mesocolon

A

mobile structure and leis between colic flexures

79
Q

left mesocolon

A

flattened against the posterior abdominal wall

80
Q

mesosigmoid

A

has a medial portion which is flattened against the posterior abdominal wall
region of mesentery associated with the colon itself is mobile

81
Q

mesorectum

A

assits in anchoring the rectum through the pelvis

82
Q

arterial supply to the mesentery

A

superior mesenteric to the organs of the midgut
inferior mesenteric to the hingut

83
Q

venous drainage of the mesentery

A

via the superior mesenertic vein
and inferior mesenteric vein

84
Q

innervation of the mesentery

A

superior mesenteric plexus
divides into many secondary plexuses containing parasympathetic and sympathetic innervation to mesentery

85
Q

lymphatics of the mesentery

A

inferior mesenteric lymph nodes receive lymph from hindgut organs and drain to the superior mesenteric
superior mesenteric receive lymph from midgut and inferior mesenteric and drain to pre-aortic

86
Q

superior mesenteric artery

A

arises from the abdominal aorta
supplies arterial blood to the organs of the midgut
level L1 vertebrae
immediately inferior to the origin of the coeliac trunk

87
Q

anatomical position of the superior mesenteric artery

A

anterior to the SMA- pyloric part of the stomach, splenic vein and neck of the pancreas
posterior to the SMA- left renal vein, uncinate process of the pancreas and inferior part of the duodenum

88
Q

uncinate process

A

only part of the pancreas that hooks around the back of the SMA

89
Q

major branches of the superior mesenteric artery

A

inferior pancreaticduodenal artery
jejunal and ileac arteries
middle and right colic arteries
ileocolic artery

90
Q

inferior pancreaticoduodenal artery

A

first branch of the SMA
forms anterior and posterior vessels
anastomose with branches of the superior pancreaticdudenal artery
supplies inferior region of the head of the pancreas, uncinate process and duodenum

91
Q

jejunal and ileac arteries

A

pass between layers of the mesentery
form anastamotic arcades which form smaller straight arteries: vasa recta arise to supply the organs

92
Q

middle colic artery

A

supplies the transverse colon

93
Q

right colic artery

A

supplies the ascending colon

Medicine Unit 3 (28 decks)

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