Basic Structures, Processes And Endoscopy

Question 1

Name the 3 pairs of salivary glands

Answer 1

Parotid
Sublingual
Submandibular

Question 2

What are the 4 layers of the gut wall?

Answer 2

Mucosa
Submucosa
Muscularis externae
Serosa

Question 3

What are Peyer’s patches?

Answer 3

Aggregations of lymphocytes often present in the lamina propria

Question 4

What constituents the mucosa?

Answer 4

Epithelium
Lamina propria
Muscularis mucosa

Question 5

What is the submucosa?

Answer 5

A layer of connective tissue bearing glands, arteries, veins and nerves

Question 6

What are the 2 layers of muscularis externae?

Answer 6

Outer = longitudinal 
Inner = circular

Question 7

What is the of IgA?

Answer 7

Secreted in saliva to bind to bacteria and prevent them getting though the epithelium

Question 8

Describe the innervation to the oesophagus

Answer 8

Myenteric plexus = between the 2 muscle layers

Submucosal plexus = between the muscularis externae and the submucosa

Question 9

What are the 3 layers of muscle in the stomach called?

Answer 9

Circular
Longitudinal
Oblique

Question 10

What are Brunner’s glands?

Answer 10

Glands that secrete bicarbonate rich mucus to neutralise the acidic chyme from the stomach

Question 11

What are plicae circulares?

Answer 11

Circular folds of mucosa and submucosa that project into the lumen of the jejunum to increase SA

Question 12

What does the duodenum absorb?

Answer 12

Iron

Question 13

What does the jejunum absorb?

Answer 13

Most sugars, amino acids and fatty acids

Question 14

What does the ileum absorb?

Answer 14

Vitamin B12, bile acids and remaining nutrients

Question 15

Where do GI contents await expulsion?

Answer 15

Colon

Question 16

Where do you find most of the GI bacteria?

Answer 16

Colon

Question 17

What type of bacteria are found in the colon?

Answer 17

99% anaerobic

Question 18

How much do we ingest per day?

Answer 18

Approx 1 kg

Question 19

How much saliva do we produce a day?

Answer 19

Approx 1.5 litres

Question 20

How much does the stomach secrete a day?

Answer 20

Approx 2.5 litres

Question 21

Which absorbs more water, the small or large intestine?

Answer 21

Small intestine

Question 22

How much faeces do we produce a day?

Answer 22

Approx 150g

Question 23

Which cells release gastrin?

Answer 23

G cells in the stomach

Question 24

What is secretin?

Answer 24

Produced by the duodenum to promote bicarbonate production in the pancreas

Question 25

What does ERCP stand for?

Answer 25

Endoscopic retrograde cholangiography and pancreatography

Question 26

What is a hiatus hernia of the oesophagus?

Answer 26

Weakness in the oesophageal hiatus allows the cardia and fundus of the stomach to herniate into the thorax

Question 27

What is the blood supply to the upper 2/3 of the oesophagus?

Answer 27

Inferior thyroid artery Aortic branches Drains = inferior thyroid vein and azygous branches

Question 28

What is the blood supply to the lower 1/3 oesophagus?

Answer 28

Left gastric branch of coeliac trunk Left inferior phrenic artery Drains = left gastric vein (portal system)

Question 29

Define achalasia

Answer 29

A condition in which the muscles of the lower oesophagus fail to relax, preventing food passing into the stomach

Question 30

What mechanisms do we have to reduce reflux?

Answer 30

Acute angle of entry of oesophagus into stomach (valve like) Mucosal folds at oesophagogastric jucntion act as a valve Right crus of the diaphragm acts as a 'pinch-cock' Positive intra-abdominal pressure compresses the walls of the abdominal oesophagus

Question 31

What is the pyloric sphincter?

Answer 31

The muscular sphincter of the stomach the controls the passage of stomach contents into the duodenum

Question 32

Where is gastric ulceration often found?

Answer 32

Lesser curve at the angulus

Question 33

What ligament supports the duodenojejunal flexure?

Answer 33

Ligament of Treitz

Question 34

At what vertebral level does the duodenum commence?

Answer 34

L1

Question 35

How many divisions of the duodenum are there?

Answer 35

4

Question 36

Describe the superior portion of the duodenum

Answer 36

``` 5cm Intraperitoneal Overlapped by liver and gall bladder Gall stones may cause erosion - can lead to fistulae here Ulcers common ```

Question 37

Describe the descending part of the duodenum

Answer 37

``` Retroperitoneal 7.5cm Curves round head of pancreas Major duodenal papilla half way along (sphincter of Oddi here) Transition from foregut to midgut ```

Question 38

What is Zollinger-Ellison Syndrome?

Answer 38

A gastrin secretion tumour of the pancreas that stimulates acid secreting cells of the stomach

Question 39

Describe the horizontal part of the duodenum

Answer 39

10cm Crosses aorta at L2/3 Can lead to aorta-duodenal fistulae (rare)

Question 40

Describe the ascending portion of the duodenum

Answer 40

2.5cm Duodenojejunal flexure Retroperitoneal

Question 41

What ducts form the common hepatic duct?

Answer 41

Left and right hepatic ducts

Question 42

Which ducts form the common bile duct?

Answer 42

Cystic duct from gall bladder and common hepatic duct

Question 43

What is the epiploic foreman of Winslow?

Answer 43

Foramen from the greater to the lesser sacs of peritoneum

Question 44

How do we control hepatic haemorrhage?

Answer 44

Pringle manoeuvre - occlude the portal vein and hepatic artery by applying pressure to the free edge of the lesser sac

Question 45

What is the anatomical difference in coeliac disease?

Answer 45

The jejunum crypts and villi atrophy

Question 46

Why does the colonic wall have haustrations?

Answer 46

The lengths of muscle are shorter than the colon itself so bunch the colonic wall

Question 47

Why is there a valve at the ileocaecal junction?

Answer 47

To prevent backflow of colonic contents

Question 48

Where is the appendix?

Answer 48

Arises from posterior-medial aspect of the caecum | Approx 3 cm below the ileocaecal valve

Question 49

Why does the sigmoid colon often twist?

Answer 49

It's very long | Has a loose mesenteric attachment

Question 50

What percentage of colon cancers are found in the rectum?

Answer 50

50%

Question 51

What are haemorrhoids?

Answer 51

Dilatations of superior rectal veins

Question 52

What distinguishes whether haemorrhoids are painful or not?

Answer 52

Origin: Above pectinate line = painless Below pectinate line = painful (extremely)

Question 53

Which pair of glands produces the most saliva?

Answer 53

Submandibular

Question 54

What is kallkrein?

Answer 54

An enzyme that helps produce bradykinin to help vasodilation - allow blood flow to get to glands