Gastrointestinal Flashcards
(114 cards)
1
Q
What is the course of the trigeminal nerve (CNV)
A
Comes off the CNS at the pons
Passes through the foramen ovale of the sphenoid bone
2
Q
How many divisions of the trigeminal nerve are there?
A
3
3
Q
What is the course of the facial nerve (CNVII)?
A
Comes off the CNS between the pons and the medulla
Leaves through the internal acoustic meatus of the temporal bone
Emerges externally through the stylomastoid foramen
4
Q
What are some of the innervations of the facial nerve?
A
Supplies muscles of facial expression
It branches in to the chorda tympani which innervates the anterior 2/3rds of the tongue and is involved in taste and sensation
It supplies the sublingual salivary glands with parasympathetic axons.
5
Q
What branch of CNV supplies what part of the oral cavity?
A
CNV2 supplies the superior oral cavity
CNV3 supplies the inferior oral cavity
6
Q
What is the course of CNV2?
maxillary division of the trigeminal nerve
A
Comes off the CNS at the pons
Exits through the foramen rotundum in the sphenoid bone
7
Q
What is the course of the glossopharyngeal nerve (CNIX) ?
A
It leaves the CNS at the medulla
Exits through the jugular foramen which is between the temporal and occipital bones
8
Q
What is the course of the hypoglossal nerve (CNXII) ?
A
Connected to the CNS via many rootlets that attach to the medulla oblongata
Leaves through the hypoglossal canal in the occipital bone
9
Q
What are the 4 pairs of muscles of mastication?
A
Temporalis
Masseter
Medial pterygoid
Lateral pterygoid
10
Q
Which three cranial nerves supply sensation to the tongue?
A
CNVII (facial nerve)
CNV3 (trigeminal)
CNIX (glossopharyngeal)
11
Q
What effect do autonomic nerves have on peristalsis?
A
Parasympathetics speed up peristalsis
Sympathetics slow down peristalsis
12
Q
At what level does the laryngopharynx become the oesophagus?
A
C6
13
Q
What is the name of the anatomical upper sphincter of the oesophagus?
A
Cricopharyngeus
14
Q
The lower oesophageal sphincter is physiological not anatomical. What two things produce its physiological effect?
A
Contraction of the diaphragm
Higher intra-abdominal pressure than intra-gastric pressure
15
Q
What 3 regions does the stomach lie in?
A
Left hypochondrium, epigastric, umbilical
16
Q
On the lesser curvature side of the stomach, what is the indent called?
A
Incisura Angularis
17
Q
Talk logically through the nine regions of the abdomen
A
Right hypochondrium, epigastric, left hypochondrium
Right lumbar, umbilical, Left lumbar,
Right inguinal, pubic, left inguinal
18
Q
What are the two ligaments of the liver?
A
Falciform ligament
Round ligament
19
Q
Which liver ligament attaches the liver to the body wall?
A
The falciform ligament
20
Q
What are the three parts of the small intestine?
A
Duodenum, Jejunum, Ileum
21
Q
What are the parts of the large intestine?
A
Appendix caecum Ascending colon Hepatic flexure Transverse colon Splenic flexure Descending colon Sigmoid colon Rectum Anal canal Anus
22
Q
Explain the musculature of the anterolateral abdominal wall
A
The rectus abdominus are the ‘ab muscles’ at the front
There are three layers of muscles at the side;
The external oblique
The internal oblique
The transverses abdominus
23
Q
If blood/pus or faeces enter the peritoneal cavity, what will this cause?
A
Peritonitis
24
Q
What is mesentery?
A
A double layer of peritoneum that comes together and wraps behind the organ
25
Name 3 retroperitoneal organs and 3 intraperitoneal organs
```
RETROPERITONEAL;
Kidneys
Adrenal Glands
Pancreas
INTRAPERITONEAL;
Stomach
Spleen
Liver
```
26
What is omentum?
A double layer of peritoneum that passes from the stomach
27
How many layers does the greater momentum have and what are its attachments?
4 Layers
It hangs over many structures
Attached to the greater curvature of the stomach and the transverse colon
28
How many layers does the lesser momentum have and what are its attachments?
2 (double-layered)
| Attached to the lesser curvature of the stomach and the liver. It has a right 'free' edge.
29
Peritoneum forms pouches at its inferior aspect. What are these pouches called in males and females?
There is 1 pouch in males - called the 'rectovesical pouch'
There are 2 pouches in females - called the 'vesicle-uterine pouch' and 'recto-uterine pouch (a.k.a pouch of douglas) in females.
30
What is ascites, what is its most common cause and how is it managed?
Ascites is a collection of fluid in the peritoneal cavity
it is most commonly caused by liver disease.
It is managed by paracentesis in which a needle is used to drain the fluid.
31
What nerves supply the abdominal organs and what nerves supply the abdominal wall?
```
ORGANS
Visceral afferents
ENS
Parasympathetics and sympathetics
WALL
Somatic sensory and motor
Sympathetics
```
32
At what level do sympathetic nerves leave the spinal cord and where do they synapse? what is the exception to this rule?
T5 - L2
Synapse at pre vertebral ganglia
*Sympathetics for the adrenal gland leave at T10-L1
Synapse directly onto the cells
33
What is the outflow of parasympathetic nerves?
CRANIAL-SACRAL OUTFLOW;
CNX (vagus)
Pelvic splanchnic nerves (S2,3 &4)
34
At what levels do visceral afferents from the different areas of the gut enter the spinal cord?
FOREGUT - T6 - T9
MIDGUT - T8 -T12
HINDGUT - T10 - L2
35
What are the common areas that the gut refers pain to?
FOREGUT - Epigastric
MIDGUT - Umbilical
HINDGUT - Pubic
36
Explain how appendicitis presents in terms of pain
Initially, the pain from appendicitis can be described as dull, and localised to the umbilical region.
As the condition worsens however the pain become sharp and 'pin-pointed' to the right iliac fossa.
The pain can be described as having changed from visceral to somatic.
37
What causes jaundice and how can it be detected?
* An increase in the blood levels of bilirubin (a normal break-down product of red blood cells)
* can be detected by;
- Yellowing of sclera
- Yellowing of the skin
- Itchiness of the skin
38
What is the role of the gall bladder?
Storage and concentration of bile
39
What is the role of bile?
It is important for the normal absorption of fats from the small intestine!
40
State 3 functions of the liver
Glycogen storage
Bile secretion
Metabolic functions
41
Describe the location of the liver and its anatomical relations
The liver is mainly located in the RUQ and is protected by ribs 7-11
Its location is affected by breathing
- Inferior to the diaphragm
- Anterior to the gallbladder
- Superior to the hepatic flexure
- Anterior to the kidney, IVC and abdominal aorta
- Anterior to the stomach
42
What are the 4 anatomical lobes of the liver?
Right lobe
Left Lobe
Caudate lobe
Quadrate lobe
43
What are the ligaments of the liver?
The falciform ligament (attaches to the body wall)
The round ligament (embryological remnant of the umbilical vein)
The triangular ligaments
The coronary ligaments
44
Where is the bare area on the liver?
The bare area is the area of the liver where there is no peritoneum as this is the attachment to the diaphragm
45
What is the porta hepatis?
The site of entrance of the portal triad structures
46
What specific vasculature do each of the 8 functional lobes of the liver all have? List 4
Branch of a hepatic artery
Branch of a hepatic portal vein
Bile drainage to the bile duct
Venous drainage to the IVC
47
Which two vessels associated with the liver lack valves?
IVC
Hepatic veins
(thus an increase in central venous pressure is directed to the liver)
48
What 3 structures make up the portal triad? And which ligament do these structures run within?
Hepatic portal vein
Hepatic artery proper
Bile duct
*Run within the hepatoduodenal ligament
49
The coeliac trunk is one of the first 3 midline branches of the aorta.
At what level does it leave the aorta?
T12
50
What 3 branches does the coeliac trunk branch into?
Splenic artery
Left gastric artery
Common hepatic artery
51
What does the common hepatic artery branch into?
Gastroduodenal
| Hepatic artery proper, then Right gastric
52
Describe the location of the spleen and its anatomical relations
Left hypochondrium, protected by ribs 9-11
Medial to the left kidney
Posterior to the stomach
Superior to the splenic flexure
53
Describe the anastomoses of the vessels supplying the stomach
Right gastric artery anastomoses with the left gastric artery at the junction of the lesser curvature and the lesser omentum
Right gastro-omental artery anastomoses with the left gastro-omental at the greater curvature and the greater omentum
54
What kind of blood supply does the liver have? What are the vessels called?
DUAL blood supply
- Right and left hepatic arteries
- Hepatic artery proper
- Hepatic portal vein
55
What structures do liver lobules contain?
Central vein
| Interlobular portal triad
56
What is the function of the hepatic portal vein?
It is formed from the splenic veins and the superior mesenteric vein which drain the foregut and midgut respectively. The vein then transports this blood to the liver.
57
Where does the inferior mesenteric vein drain blood from?
It drains blood from the hindgut to the splenic vein, which then becomes the hepatic portal vein, and drains back to the liver
58
Name the two recesses around the liver in the peritoneal cavity within the greater sac
Subphrenic recess
| Hepatorenal recess
59
What are the lowest parts of the peritoneal cavity when the patient is supine?
Hepatorenal recess
| Rectovesical/ recto-uterine pouch
60
Describe the location of the gall bladder
It lies on the posterior aspect of the liver, anterior to the duodenum
61
Explain the blood supply to the gall bladder
The cystic artery (a branch of the right hepatic artery) - it branches within the triangle of clot before entering the gall bladder
62
Explain how gall bladder pain may be felt
The gall bladder is a foregut organ and so visceral afferents enter the spinal cord between T6-T9 - early pain is felt in the epigastric region
Pain can later present in the hyperchondrium, with or with out referral to the right shoulder/neck
63
What is the term used to describe surgical removal of the gall bladder
Cholecystectomy
64
Describe the relationship of the duodenum with the peritoneum
The 1st part is intraperitoneal
| 2nd, 3rd and 4th parts are retroperitoneal
65
Which two peptide hormones does the duodenum secrete?
Gastrin
| CCK
66
What does the head of the pancreas have?
An uncinate process
67
Which cells make up the exocrine pancreas and are responsible for secreting enzymes?
Acinar cells
68
Which cells make up the endocrine pancreas and are responsible for secreting hormones?
Islets of Langerhan
69
Explain the nerve supply to the pancreas
abdomino pelvic splanchnic nerves - SYMPATHETIC
Vagus nerve - PARASYMPATHETIC
VISCERAL AFFERENTS
70
The bile duct joins with the main pancreatic duct to form what structure?
The hepatopancreatic ampulla (of Vater)
71
Where does the hepatopancreatic ampulla drain into?
The 2nd part of the duodenum
72
How many sphincters are involved in the drainage of the biliary system and what are they called?
3
- Bile duct sphincter
- Pancreatic duct sphincter
- Sphincter of Oddi
73
What two things can obstruct the biliary tree, causing jaundice?
- Gallstones
- Carcinoma at the head of the pancreas (blocks sphincters)
* These things cause flow of bile back up to the liver and overspill of bile and bilirubin into the blood.
74
Which two vessels anastomose at the pancreas?
Superior pancreaticduodenal artery
| Inferior pancreaticduodenal artery
75
Where can pancreatic pain radiate to?
The back
76
What two signs can vascular haemorrhage presents with as a consequence of acute pancreatitis?
Grey-turner's sign
(huge deep purple bruises on the flanks)
Cullen's sign
(deep purple around the umbilicus)
77
What are the main groups of abdominal lymph nodes?
Celiac
Superior mesenteric
Inferior mesenteric
Lumbar
78
Where do the left and right venous angles drain into?
Left - thoracic duct
| Right - right lymphatic duct
79
Where are paracolic gutters found and what can accumulate here?
Greater sac in the peritoneal cavity - between the ascending/ descending colon and the abdominal wall
(pus can accumulate here)
80
What are the omental appendices on the colon?
Small fatty projections
81
What are teniae coli?
The 3 distinct bands of longitudinal muscle on the colon
82
What are haustra?
The pouches which give the colon its segmental appearance
83
What are the two orifices on the caecum?
The appendiceal orifice (at McBurney's point)
| The ileocaecal orifice
84
At what level do the three branches of the abdominal aorta come off?
Celiac trunk - T12
Superior Mesenteric artery - L1
Inferior Mesenteric artery - L3
85
What are the branches of the SMA? (6)
```
Inferior pancreaticduodenal artery
Middle colic artery
Right colic artery
Ileocolic artery
Jejunal and Ileal arteries
```
86
Describe the differences between the jejunal and ileal arteries in terms of vasa rectae and arcades
```
JEJUNUM
- Longer vasa rectae
- Less complex arcades
ILEUM
- Shorter vasa rectae
- more complex arcades
```
87
What are the branches of the IMA? (3)
Left colic artery
Sigmoid arteries
Superior rectal artery
88
The Marginal Artery of Drummond involves the anastomosis of which 2 vessels?
Superior and Inferior mesenteric arteries
89
There are two venous systems in the body - where do these drain to?
Hepatic Portal Venous System - drains to the liver
| Systemic Venous System - drains to the IVC
90
What are the three important sites of venous anastomosis between the portal and systemic circulations?
Distal end of the oesophagus
Skin around the umbilicus
Rectum/ anal canal
91
How can portal hypertension present clinically?
Oesophageal varices
Caput medusa
Rectal varices
92
What muscle makes up the pelvic floor?
Levator Ani Muscle
93
At what vertebrae level does the sigmoid colon become the rectum and what is this junction called?
S3
| Rectosigmoid junction
94
What pouch is formed in males between the bladder and the rectum?
Rectovesical pouch
95
what pouch is formed in females between the uterus and the rectum?
Rectouterine pouch
96
What 3 smaller muscles make up the levator ani muscle?
iliococcygeus
pubococcygeus
Puborectalis
97
What is the nervous supply of the levator ani muscle?
A branch of the sacral plexus involving S2, 3 & 4
98
Which smaller muscle within the levator ani muscle has a crucial role in maintaining faecal continence?
Puborectalis
99
Which nerve fibres stimulate contraction of the internal anal sphincter and which stimulate contraction of the external anal sphincter?
Sympathetics - Internal
| Pudendal - external
100
Which kind of muscle is the internal and external anal sphincter made up of? Which is voluntary and which is involuntary?
Internal anal sphincter - smooth muscle, involuntary
| External anal sphincter - skeletal muscle, voluntary
101
Which area of the spinal cord do sympathetic fibres come from which cause contraction of the internal anal sphincter and cause inhibition of peristalsis?
T12 - L2
102
```
Which area of the spinal cord do;
- somatic motor (pudendal)
- parasympathetic fibres
- visceral afferents
come from?
```
S2 - S4
103
Which nerves do parasympathetic fibres run alongside?
Pelvic splanchnic nerves
104
Which foramen does the pudendal nerve pass through?
Greater sciatic foramen - exits the pelvis
| Lesser sciatic foramen - enters the perineum
105
What does the pectinate line mark the junction between?
The part of the embryo which formed the GI tract (endoderm) and the part which formed the skin (ectoderm)
106
Is above the pectinate line endoderm or ectoderm derived?
Above the line - endoderm
| Below the line - ectoderm
107
What is a rectal varice and why does it form?
A dilation of collateral veins between the portal and the systemic venous system which forms due to portal hypertension
108
Why do haemorrhoids form?
Haemorrhoids form due to raised pressure. E.g coughing and constipation
109
What is the name of the fossae which lie either side of the anal canal?
Ischioanal fossae
110
Describe the location of the parotid gland and how its secretions enter the mouth
Anterior to the ear, Inferior to the zygomatic arch
| - The duct of stensen enters the mouth opposite second maxillary molar teeth
111
Describe the location of the submandibular gland and how its secretions enter the mouth
Medial to the body of the mandible on the floor of the mouth
- The duct of wharton enters the mouth under the tongue by lingual frenulum via sublingual caracula
112
Describe the location of the sublingual gland and how its secretions enter the mouth
Medial to the submandibular glands
| - The duct of rivinus and common bartholin connect with wharton's at the sublingual caruncular
113
Describe he anatomy of the inguinal canal in terms of the walls and the floor and roof
Posterior wall = transversals fascia
Anterior wall = aponeurosis of external oblique, internal oblique
Floor =
Inguinal ligament and the lacunar ligament
Roof =
Transversalis fascia
Internal oblique
Transversus abdominus
114
At what level do the iliohypogastric and the ilioninguinal nerves branch off the intercostal nerves?
At the level of L1
