How long is the oesophagus?
25cm
What vertebral level is the oesophageal hiatus?
T10
Where are the three constrictions of the oesophagus located?
Cervical, Thoracic, Diaphragmatic
List the structures that go through the oesophageal opening in the diaphragm.
Oesophagus
oesopheageal branch of left gastric artery
vagus
left inferior phrenic vessels
What is the blood supply of the abdominal part of the oesophagus?
Branches of left gastric artery
What is the venous drainage of the abdominal part of the oesophagus?
Left gastric veins
What is the lymphatic drainage of the abdominal part of the oesophagus?
Left gastric lymph nodes
Stomach: name 2 orifices.
Cardial
Pyloric
Stomach: name 2 curvatures.
Greater curvature
Lesser curvature
Stomach: name 2 surfaces.
Anterior
Posterior
Identify the different parts of the stomach:
Cardia
Body
Fundus
Pylorus
See image
What is the pyloric sphincter?
Ring of smooth muscle controlling discharge of stomach contents into duodenum
Clinical aspects of pyloric sphincter: some children are born with ___________ ____________ ___________, presenting as _____________.
congenital pyloric stenosis
presents with vomiting.
What are the gatric folds/rugae of the stomach formed from?
Mucosal folds
In what 2 portions of the stomach are they most apparent?
Pylorus
Greater Curvature
Describe the arterial supply to the stomach.
Lesser curvature
Left gastric artery (from coeliac trunk)
Right gastric artery (from common hepatic)
Greater Curvature
Left gastro-omental artery (from splenic artery)
Right gastro-omental artery (from common hepatic)
Name the 4 groups of lymph nodes that drain the stomach.
Gastric
Pyloric
Pancreatosplenic
Pancreaticoduodenal
The 4 primary lymph nodes that drain the stomach drain into which group of lymph nodes?
Coeliac lymph nodes
What nerve is key to controlling gastric motility?
Vagus
What is the effect of increased vagal stimulation on the pyloric sphincter?
Relaxes and opens
What is the effect of increased vagal stimulation on gastric secretions?
Increased secretions
Name 3 parts of the small intestine
Duodenum, Jejunum, Illeum
Which part of the small intestine receives the opening of the bile and pancreatic duct?
Major duodenal papilla (duodenum)
Where is the foregut/ midgut boundary in the small intestine?
1/3rd of way along duodenum.
Which part of the small intestine is the shortest, widest and most fixed part?
Duodenum
Compare the jejunum and illeum in life.
Colour, Wall, Vascularity, Vasa recta Arcades, Fat in mesentery, Circular folds
How is the large intestine peritonised?
Caecum Ascending Colon Transverse Colon Descending Colon Sigmoid Colon
Caecum - intra
Ascending Colon - retro
Transverse Colon - intra
Descending Colon - retro
Sigmoid Colon - intra
In which abdominal region is the caecum and appendix located?
Right illiac
What is the midgut/hindgut boundary in the large intestine?
2/3rds along Transverse Colon
Which two structures open into the cavity of caecum?
Appendix
Illeum
What is McBurney’s point and why is it useful clinically?
1/3rd along line between Right ASIS and umbilicus.
Site of maximum tenderness in acute apendicitis
Describe the arterial supply and venous drainage of the rectum.
Superior 1/3rd: superior rectal artery and vein
Middle 1/3rd: middle rectal artery and vein
Lower 1/3rd: Inferior rectal artery and vein
Of the 2 anal sphincters, which is visceral and which is somatic?
External anal sphincter = somatic
Internal anal sphincter = visceral
What is the falciform ligament and what structure runs within the free border of it?
Falciform ligament seperates Right and Left lobes of the liver.
Ligamentum teres (round ligament of liver) lies wihtin its free border.
What is the ligamentum teres a remnant of?
Fetal umbilical vein
How many layers of the peritneum are present in the greater omentum?
4
(double sheet)
What are the paracolic gutters?
Grooves between lateral aspects of colon and postero-lateral abdomninal wall.
Where are the paracolic gutters found in relation to the large intestine?
Laterally.
List 3 abdominal viscera which lie on a mesentery.
Sigmoid colon
Transverse colon
Small intestine
What muscle type forms the muscularis externa in the oesophagus?
Upper 1/3rd: skeletal muscle
Middle 1/3rd: Skeletal + Smooth
Lower 1/3rd: Smooth muscle
What kind of epithelium is present in the oesophagus?
Non-keratinised Stratified squamous
What type of muscle is present in the muscularis mucosae in the oesophagus?
Smooth muscle
Stomach: what are the large folds present in the wall?
Rugae
Stomach: what secretory cells are loacted in the gastric pits?
Surface mucous cells.
Small intestine: what are the large folds extending into the lumen called?
Plicae circularis
Super imposed on each large fold is numourous finger like processes. What are these?
Villi
Small intestine: what kind of epithelium is present in one of these finger like villi?
Simple columnar
Where, along the gut tube, do glands extend down beyond the muscularis mucosae (interna) into the submucosa?
Oesophagus, Duodenum
Small intestine: What appear to be ‘spaces’ can be seen scattered between the cells of the surface epithelium: these are actually the contents of secretory cells. What are the cells called and what do they secrete?
Crypts of Lieberkuhn
Secrete water
Colon: what is the predominant cell type in the epithelium?
Simple columnar
Recto-anal junction: what type of epithelium?
Stratified Squamous
What is the transpyloric plane?
Horizontal line passing through pylorus of stomach
How would you locate the transpyloric plane on a patient?
Midway between jugular notch and pubic symphysis.
List the structures present in the transpyloric plane.
Neck of Pancreas
Pylorus
Spleen
L1
Duodenum (2nd part)
What aggregations are a distinguishing feature of the illeum?
Peyer’s Patches
Histology - how can you differentiate the jejunum from the duodenum and illeum?
Villi without brunners glands or peyer’s patches.
Histology - what is the characteristic feature of the sub-mucosa of the duodenum?
Brunner’s Glands
(sub-mucosa packed full of these small, white glands)
