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Semester 4: Nutrition and Metabolism > Anatomy Topic 4 Case 4 > Flashcards

Anatomy Topic 4 Case 4 Flashcards

(76 cards)

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1
Q

How long is the small intestine?

A
  • 6 to 7 m
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2
Q

How long is the duodenum?

A
  • 20 to 25 cm
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3
Q

Is the duodenum retroperitoneal or intraperitoneal?

A
  • Retroperitoneal

- Except for the first part which is connected to the liver by the hepatoduodenal ligament

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4
Q

Identify the four parts of the duodenum

A
  • Superior
  • Descending
  • Inferior
  • Ascending
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5
Q

At what vertebral level is the superior part of the duodenum?

A
  • To the right of L1
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6
Q

The superior part of the duodenum passes anteriorly over which structures?

A
  • Bile duct
  • Gastroduodenal artery
  • Portal vein
  • Inferior vena cava
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7
Q

What is the clinical significance of the superior part of the duodenum?

A
  • Ampulla

- The point of the duodenum at which ulcers are most likely to occur

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8
Q

At what vertebral level does the descending part of the duodenum reach?

A
  • To the right of L3
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9
Q

Identify the structure that passes anterior and the structure that passes posterior to the descending part of the duodenum

A
  • Anterior: Transverse colon

- Posterior: Right kidney

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10
Q

Identify two features of the descending part of the duodenum

A
  • Major duodenal papilla

- Minor duodenal papilla

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11
Q

Identify a structure that passes anterior to the inferior part of the duodenum

A
  • Superior mesenteric artery and vein
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12
Q

At what vertebral level does the ascending part of the duodenum reach?

A
  • To left of L2
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13
Q

What is the duodenojejunal flexure? Identify one feature of it

A
  • Point at which duodenum terminates
  • Surrounded by a fold of peritoneum containing muscle fibres
  • Called the suspensory muscle of duodenum (ligament of Treitz)
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14
Q

Outline the arterial supply to the duodenum

A
  • Gastroduodenal artery (from common hepatic artery)
  • Supraduodenal artery (from gastroduodenal artery)
  • Anterior + posterior superior pancreaticoduodenal arteries (from gastroduodenal artery)
  • Anterior + posterior inferior pancreaticoduodenal arteries (from inferior pancreaticoduodenal artery from superior mesenteric artery)
  • First jejunal branch of superior mesenteric artery
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15
Q

Describe the venous drainage of the duodenum

A
  • Superior pancreaticoduodenal veins drain into portal vein

- Inferior pancreaticoduodenal veins drain into superior mesenteric vein

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16
Q

Describe the lymphatic drainage of the duodenum

A
  • Drains upward via pancreaticoduodenal nodes to gastroduodenal nodes into coeliac nodes
  • Drains downward via pancreaticoduodenal nodes to superior mesenteric nodes
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17
Q

Outline the innervation of the duodenum

A
  • Sympathetic and parasympathetic innervation from coeliac and superior mesenteric plexuses
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18
Q

Describe features of the jejunum

A
  • Proximal 2/5
  • In left upper quadrant
  • Fewer arterial arcades
  • Longer vasa recta
  • Less mesenteric fat
  • More prominent plicae circulares
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19
Q

Describe features of the ileum

A
  • Distal 3/5
  • In lower right quadrant
  • More arterial arcades
  • Shorter vasa recta
  • More mesenteric fat
  • Less prominent plicae circulares
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20
Q

Identify the arterial supply of the jejunum and ileum

A
  • Jejunal and ileal branches of superior mesenteric artery

- Ileum also supplied by ileal branch of ileocolic artery

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21
Q

With regards to Meckel’s diverticulum identify its:

  • Pathology
  • Epidemiology
  • Clinical features
  • Treatment
A
  • Remnant of the yolk sac that lies on the antimesenteric border of the ileum
  • 2% of patients
  • Haemorrhage, diverticulitis, ulceration, obstruction
  • Surgical removal laparoscopically
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22
Q

Describe the features of the mucosa of the duodenum

A
  • Long villi interspersed with crypts of Lieberkuhn

- Brunner’s glands open into muscularis mucosae

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23
Q

Describe the features of the mucosa of the ileum

A
  • Transverse folds (plicae circulares) covered with short villi
  • Peyer’s patches
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24
Q

How does the distribution of plicae circulares change through the small intestine

A
  • Most prominent in jejunum and proximal ileum

- Absent in proximal duodenum and distal ileum

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25
What type of epithelium lines the crypts of Lieberkuhn?
- Simple columnar epithelium
26
Identify 5 cell types that line the crypts of Lieberkuhn and their function
- Enterocytes: Absorption - Goblet cells: Mucus production - Paneth cells: Defensive function (eosinophilic granules - Neuroendocrine cells: Motility (hormones) - Stem cells: Replenish all of the above cells
27
Identify two features of enterocytes that protect the small intestine from auto-digestion
- Goblet-cell derived mucus | - Glycocalyx
28
What is responsible for absorption of pancreatic enzymes from small intestine?
- Glycocalyx
29
Where are lacteals located and what is their role?
- Run through centre of villi - Drain tiny lymphatic vessels - Transport absorbed lipid into circulatory system via lymphatic duct
30
Describe two additional protective mechanisms of the small intestine
- T lymphocytes are scattered among enterocytes | - Plasma cells secrete IgA
31
How long is the large intestine?
- 1.5 m
32
Identify four characteristics of the large intestine
- Larger diameter than small intestine - Peritoneal-covered accumulations of fat (omental appendices) - Segregation of longitudinal muscle into three narrow bands (taeniae coli) - Sacculations known as haustrations
33
In which abdominal region is the cecum located?
- Right iliac fossa
34
Is the cecum intraperitoneal or retroperitoneal?
- Intraperitoneal | - Because of its mobility not because of its suspension by mesentery
35
What is the appendix?
- Narrow, hollow, blind-ended tube connected to the cecum
36
Identify two functions of the mesoappendix
- Suspends appendix form terminal ileum | - Contains appendicular vessels
37
Identify four possible locations of the appendix
- Retrocecal - Retrocolic - Subcecal - Preileal - Postileal
38
Identify the surface projection of the appendix
- One third the distance from the ASIL to the umbilicus
39
Identify the arterial supply to the cecum and appendix
- Anterior cecal artery - Posterior cecal artery - Appendicular artery - All of which are from the ileocolic artery - A branch of the superior mesenteric artery
40
Identify the pathology of appendicitis
- Obstruction from fecalith or enlargement of lymphoid nodules - Causing proliferation of bacteria - Resulting in invasion of appendix wall, which becomes damaged by pressure necrosis
41
Outline the clinical features of appendicitis
- Periumbilical pain that becomes localised to right iliac fossa - Associated with fever, vomiting and nausea
42
Outline the investigation and treatment of appendicitis
- Ultrasound scan | - Appendectomy
43
Identify the parts of the colon
- Ascending colon - Hepatic flexure - Transverse colon - Splenic flexure - Descending colon - Sigmoid colon
44
What are the paracolic gutters?
- Formed between lateral margins of ascending and descending colon and posterolateral abdominal wall - Through which material can pass through peritoneal cavity - Which is free of vessels and lymphatics allowing for mobilisation of the ascending and descending colons
45
To which vertebral level does the sigmoid colon descend to?
- S3
46
Identify the arterial supply to the ascending colon
- Colic branch from ileocolic artery - Anterior cecal artery - Posterior cecal artery - Right colic artery - All of which arise from the superior mesenteric artery
47
Identify the arterial supply to the transverse colon
- Right colic artery (SMA) - Middle colic artery (MSA) - Left colic artery (IMA)
48
Identify the arterial supply to the descending colon
- Left colic artery | - From inferior mesenteric artery
49
Identify the arterial supply to the sigmoidal colon
- Sigmoid arteries | - From inferior mesenteric artery
50
How is the perineal flexure (anorectal junction) formeD?
- By action of the puborectalis muscle | - So the anal canal moves in a posterior direction as it passes through the pelvic floor
51
Identify the three lateral curvatures of the
- Upper and lower curvatures on the right | - Middle curvature on the left
52
What is the rectal ampulla?
- Expanded lower part of the rectum
53
What are anal columns / columns of Morgagni?
- Longitudinally oriented folds | - Which are united inferiorly by crescentic folds termed anal valves
54
What is the pectinate line?
- Circle formed around the anal canal by the anal valves | - Marks position of the anal membrane in the foetus
55
What is the anal pecten?
- Transition line lined by non-keratinised stratified squamous epithelium. - Ending inferiorly as the anocutaneous line (white line)
56
Outline the arterial supply to the rectum and anus
- Superior rectal artery (from inferior mesenteric artery) - Middle rectal artery (from internal iliac artery) - Inferior rectal artery (from internal pudendal artery from internal iliac artery)
57
What is the arterial supply to the hindgut?
- Inferior mesenteric artery
58
At which vertebral level does the inferior mesenteric artery arise?
- L3
59
Identify the branches of the inferior mesenteric artery
- Left colic artery - Sigmoid arteries - Superior rectal artery
60
Identify the part of the vascular supply of the hindgut that is vulnerable to ischaemia
- Watershed area between superior mesenteric and inferior mesenteric artery at splenic flexure
61
Which structures are drained by the inferior mesenteric vein?
- Rectum - Sigmoid colon - Descending colon - Splenic flexure
62
Outline the course of the inferior mesenteric vein
- Beings as superior rectal vein - Which receives tributaries from sigmoid veins and left colic vein - It passes posterior to body of pancreas - To join splenic vein (though it can join superior mesenteric vein)
63
What are Peyer's patches?
- Lymphoid tissue | - Found in the mucosa of the ileum and ileocecal junction
64
Identify the two cell types of the colon and their arrangement
- Absorptive and goblet cells - Arranged in closely packed straight tubular glands - Which extend down to muscularis mucosae
65
What fills the space between the glands of the large intestine?
- Lamina propria | - Containing blood vessels into which water is absorbed
66
Outline the defence mechanisms of the colon
- Lamina propria contains collagen, lymphocytes (lymphoid aggregates) and plasma cells
67
How does the mucosa of the rectum differ to that of the rest of the colon?
- Contains more goblet cells
68
Identify the epithelial transitions through the rectum and anus
- Columnar (colon and rectum) to stratified squamous epithelia from the anorectal junction
69
Identify the two haemorrhoidal plexuses of the anus
- Internal plexus in the submucosa above the pectinate line | - External plexus in the submucosa between the anal canal and perianal skin
70
Which artery supplies the midgut?
- Superior mesenteric artery
71
At which vertebral level is the superior mesenteric artery located?
- Lower part of L1
72
What crosses the anterior surface of the superior mesenteric artery?
- Splenic vein | - Neck of pancreas
73
What crosses the posterior surface of the superior mesenteric artery?
- Left renal vein - Uncinate process - Inferior part of duodenum
74
Identify the branches of the superior mesenteric artery
- Inferior pancreaticoduodenal artery - Jejunal arteries - Ileal arteries - Ileocolic artery - Right colic artery - Middle colic artery
75
What do the jejunal and ileal arteries pass through?
- Mesentery | - Forming arcades as they pass outward to supply the small intestine
76
What does the middle colic artery pass through?
- Transverse mesocolon where it divides into left and right branches

Semester 4: Nutrition and Metabolism (17 decks)

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