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Case 6 > Case 6 - Upper GI revision > Flashcards

Case 6 - Upper GI revision Flashcards

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1
Q

where does the oesophagus begin and end?

A

The oesophagus begins in the laryngopharynx at C6 and extends down to T11

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2
Q

what is the oesophagus

A

A Muscular tube that expands with food going down it

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3
Q

what does the oesophagus contain [muscles]?

A

2 layers of muscle (outer longitudinal and inner circular) for peristalsis

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4
Q

how is the Oesophagus positioned anteriorly and posteriorly?

A

Positioned in-between the vertebrae posteriorly and the trachea anteriorly

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5
Q

what vertebral level is the nasopharynx

A

at C1/C2

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6
Q

The oesophagus has 3 portions, which are:

A

cervical part
thoracic part
abdominal part

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7
Q

Food which travels down the oesophagus enters the stomach by passing through the ______1______ of the diaphragm then through the ______2_______ at the level of approximately ___3__ to enter into the stomach

A

1 - abdominal hiatus
2 - lower oesophageal sphincter
3 - T10

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8
Q

the cervical part of the oesophagus extends between what

A

cricoid (C5/C6) to sternal notch

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9
Q

the Thoracic part of the oesophagus extends between what

A

Thoracic aperture (T1) to oesophageal hiatus (T10)

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10
Q

the Abdominal part of the oesophagus extends between what

A

Oesophageal hiatus to stomach

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11
Q

The oesophagus has 3 normal constrictions, which are where?

A

Upper oesophageal/cervical (C5/C6)
Middle oesophageal/thoracic (T4/5)
Lower oesophageal/abdominal (T10/11)

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12
Q

the Upper oesophageal/cervical (C5/C6) oesophageal constriction is due to what?

A

due to cricoid cartilage

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13
Q

the Middle oesophageal/thoracic (T4/5)
oesophageal constriction is due to what?

A

→ due to the arch of aorta

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14
Q

the Lower oesophageal/abdominal (T10/11)
oesophageal constriction is due to what?

A

→ due to the oesophageal hiatus of the diaphragm

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15
Q

why are the oesophageal constriction sites important?

A

food can get trapped at these sites

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16
Q

parasympathetic and sympathetic innervation of Upper ½ Oesophagus

A

recurrent laryngeal n. - parasympathetic innervation
and
cervical sympathetic trunk -sympathetic innervation

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17
Q

parasympathetic and sympathetic innervation of Lower ½ Oesophagus

A

oesophageal plexus - mixture of parasympathetic and Sympathetic Nerve fibres from the vagus nerve and sympathetic trunk
vagus nerve - gives parasympathetic innervation
sympathetic trunk - gives sympathetic innervation

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18
Q

motor innervation to oesophagus

A

Upper 1/3 oesophagus: recurrent laryngeal n.
Lower 2/3: oesophageal plexus (vagus n.)

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19
Q

Tone of the esophageal sphincters is maintained by?

A

a tightly regulated interplay between the sympathetic and parasympathetic nerves.

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20
Q

Oesophagus – blood supply

A

Upper 1/3 – Inferior thyroid a. (branch of thyrocervical trunk- subclavian a.)
Middle 1/3 – branches from the thoracic aorta (oesophageal a.)
Lower 1/3 - Left gastric a. and left inferior phrenic a.

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21
Q

Oesophagus – venous drainage

A

Upper 1/3 – inferior thyroid vein

Middle 1/3 – azygos and hemiazygos veins

Lower 1/3 – left gastric vein→ HPV (hepatic portal vein)

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22
Q

what is the stomach

A

The stomach is a roughly bean-shaped, muscular sac which can be anatomically divided into different regions

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23
Q

what regions can the stomach be divided into

A

Fundus
Cardia
Body
Pyloric antrum
Pyloric canal
Lesser curvature
Greater curvature
Angular incisure / notch
Cardiac notch

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24
Q

what are the 3 layers of muscle of the stomach

A

Outer longitudinal layer
Middle circular layer
Inner oblique layer

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25
stomach has Series of internal folds – rugae. why?
Increases surface area to allow stomach to expand
26
when does the duodenum begin?
The duodenum is C shaped and begins immediately after the pyloric sphincter [duodenum is the shortest part of the small intestine]
27
The duodenum can be divided into 4 distinct parts, which are:
Superior Descending Horizontal Ascending
28
The descending part of the duodenum has two openings for bile to enter, which are:
Major duodenal papilla Minor duodenal papilla
29
The duodenum also has internal circular folds, which are called
→ valves of Kerckring
30
Major duodenal papilla is surrounded by
→ Sphincter of Oddi
31
Minor duodenal papilla has a direct route for what?
Direct route for accessory pancreatic duct
32
Circular folds- Valves of Kerckring are also known as?
Plicae circulares (seen in duodenum and jejunum) these folds plicae circulares/valves of Kerkring are permanent – unlike the rugae in the stomach
33
function of Plicae circulares
Slows the passage of food and increases Surface area
34
Brunner’s glands are present microscopically - roles of this?
secrete alkaline fluid → Neutralises stomach acid and for lubrication
35
3 main branches off the abdominal aorta associated with blood supply to the GI tract (they pass off the anterior surface of Abdominal aorta)
Coeliac trunk Superior mesenteric Inferior mesenteric
36
The GI tract is divided based on vascular supply into 3 parts (embryology), which are:
foregut midgut hindgut
37
what landmark separates foregut and midgut
major duodenal papilla
38
what landmark separates midgut and hindgut
2/3rds along the transverse colon
39
is lower oesophagus part of foregut
yes
40
is upper anal canal part of hindgut
yes
41
The coeliac trunk arises from what?
trunk arises from the anterior surface of the abdominal aorta at the vertebral level of T12 and then it immediately divides into 3 main branches
42
what are the 3 main branches of the coeliac trunk?
Left gastric Splenic Common hepatic
43
The left gastric a. goes directly to the structures it supplies, which structures does it supply?
left half of the lesser curvature of the stomach & lower part of oesophagus
44
The splenic artery travels towards the ____1___and it gives off branches to the ____2___
1 - spleen 2 - pancreas
45
along the pathway of the splenic artery, as it travels towards the spleen and gives off branches to the pancreas, what other branches does it give off?
left gastroepiploic artery Near its termination at the spleen, the artery gives off many short gastric branches
46
what does the left gastroepiploic artery supply
left half of the greater curvature of the stomach
47
what does the short gastric branches supply
fundus region of the stomach
48
the common hepatic a. travels towards what?
liver
49
as the common hepatic a. travels towards the liver, what branches does it give off?
Right gastric artery gastroduodenal artery
50
right gastric artery supplies what
right half of the lesser curvature of the stomach
51
gastroduodenal artery further divides into the?
Right gastroepiploic artery Superior pancreaticoduodenal arteries
52
Right gastroepiploic artery supplies what
right half of the greater curvature of the stomach
53
Superior pancreaticoduodenal arteries supply what
duodenum (& pancreas)
54
The common hepatic a. terminates as the?
proper hepatic a.
55
The Right and left hepatic arteries are branches of the?
proper hepatic a.
56
the right and left hepatic arteries divide where?
Divide inferior to the porta hepatis and supply their respective lobes of the liver
57
Cystic artery is a branch of the what?
branch of the right hepatic artery
58
cystic artery supplies what
supplied gallbladder
59
60
duodenum is embryologically part of which parts of the gut?
embryologically part of the fore and midgut
61
The duodenum receives blood supply from the?
coeliac trunk (gastroduodenal a.) - Superior pancreaticoduodenal, which has anterior and posterior branches superior mesenteric artery - inferior pancreaticoduodenal, which has anterior and posterior branches
62
Innervation to the GI tract from what?
intrinsic innervation from the enteric nervous system extrinsic innervation from CNS which includes both sympathetic innervation and parasympathetic innervation
63
SYMPATHETIC INNERVATION comes from what nerves
Splanchnic nerves - greater, lesser, least, lumbar splanchnic nerves
64
PARASYMPATHETIC INNERVATION comes from what nerves
Pelvic splanchnic nerves, Vagus nerve
65
66
lesser splanchnic nerves leave spinal chord at what level
T10-T11
67
least splanchnic nerves leave spinal chord at what level
T12
68
69
the prevertebral ganglia of greater splanchnic nerves is where?
coeliac ganglia
70
the prevertebral ganglia of lesser splanchnic nerves is where?
aorticorenal ganglion
71
the prevertebral ganglia of least splanchnic nerves is where?
superior mesenteric ganglion
72
the prevertebral ganglia of lumbar splanchnic nerves is where?
inferior mesenteric ganglion
73
anterior and posterior vagal trunks are continuations of what?
continuation of the left and right vagus nerves respectively (from the esophageal plexus)
74
The anterior vagal trunk (derived from the left vagus nerve) and the posterior vagal trunk (derived from the right vagus nerve) enter the abdomen through the?
oesophageal hiatus of the diaphragm.
75
The anterior vagal trunk supplies what?
the anterior portion of the body of the stomach, the liver and a branch supplies the pylorus
76
The posterior vagal trunk supplies what?
the posterior part of the stomach, a small part of the anterior body, and also the small intestine
77
Sensory nerve fibres travel via the sympathetic nerves , and do these spinal levels match the sympathetic innervation to abdominal viscera
yes
78
Pain stimuli are carried via the sympathetic nerves too , but do the spinal cord level match?
no
79
pain stimuli from greater splanchnic nerve leaves the spinal cord at what level?
T6-T9
80
pain stimuli from lesser splanchnic nerve leaves the spinal cord at what level?
T8-T12
81
pain stimuli from least splanchnic nerve leaves the spinal cord at what level?
T12
82
pain stimuli from lumbar splanchnic nerve leaves the spinal cord at what level?
T12-L2
83
What is the Enteric Nervous System (ENS)?
A specialized network of neurons within the walls of the gastrointestinal (GI) tract Known as the “second brain” due to its autonomy and complexity Regulates GI function: motility, secretion, absorption, and local blood flow
84
Anatomical Structure of ENS
Two main plexuses: * Myenteric (Auerbach’s) plexus – controls smooth muscle contraction (motility) * Submucosal (Meissner’s) plexus – regulates secretion and blood flow
85
Key Functions of the ENS:
* Coordinates peristalsis and segmentation of intestinal contents * Regulates secretion of enzymes, hormones, and mucus * Modulates immune responses and communicates with gut-associated lymphoid tissue (GALT) * Controls local vasodilation and blood flow
86
parasympathetic system effects on ENS are?
Parasympathetic system (via vagus and pelvic nerves) – stimulates ENS activity
87
sympathetic system effects on ENS are?
* Sympathetic system – inhibits ENS activity and blood flow during stress
88
what is the diaphragm?
The diaphragm is an unpaired skeletal muscle that separates the thoracic and abdominal cavities from each other by closing the inferior thoracic aperture. The diaphragm is the primary muscle that is active in inspiration.
89
the 3 main muscular attachments of the diaphragm?
sternal part - xiphoid process lumbar part - forms medial and lateral arcuate ligaments costal part - internal surface b/w 7th and 12th ribs
90
diaphragm - oesophogeal opening is at vertebral level?
T10
91
diaphragm - vena cava opening is at vertebral level?
T8
92
diaphragm - aortic opening is at vertebral level?
T12
93
blood supply of superior surface of diaphragm
Internal thoracic a. (pericardiacophrenic a. and musculophrenic a. ) Superior phrenic a. (from thoracic aorta)
94
blood supply of inferior surface of diaphragm
Inferior phrenic a. (abdominal aorta)
95
motor innervation of diaphragm
Phrenic n. (C3-C5). 
96
sensory innervation of diaphragm
Sensory (pain and proprioception): central portion - phrenic n. peripheral portions - 5th to 11th intercostal nerves.
97
what are hiccups
A very common disorder of the diaphragm Sudden, involuntary contractions of the diaphragm causing a sharp intake of breath ‘hic’
98
hiccups occur due to what
Hiccups occur due to involuntary, intermittent contraction of the muscle. They are usually caused by consumption of large volumes of food over a short amount of time irritating the diaphragm. Other causes: Stress, excitement or nervousness can trigger hiccups, temperature changes, consuming very hot or cold foods can irritate the diaphragm, swallowing air (chewing gum / smoking), drinking carbonated drinks.

Case 6 (12 decks)

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