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Medicine Phase 1 > Gastrointestinal ANATOMY > Flashcards

Gastrointestinal ANATOMY Flashcards

1
Q

What 2 vertical lines divide the abdomen into it’s 9 nine regions?

A

Mid-clavicular lines that extend to the mid-inguinal point.

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2
Q

What 2 horizontal lines divide the abdomen into it’s 9 nine regions?

A

Upper - Subcostal: joins lower costal margins.
Lower - Intertubercular: connects the iliac crests.

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3
Q

How would you draw the transpyloric plane?

A

Half way between the suprasternal notch and the pubic symphysis.

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4
Q

What vertebral level is the transpyloric plane found?

A

L1.

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5
Q

Name 5 structures found on the transpyloric plane.

A
  1. Pylorus of stomach.
  2. Fundus of gall bladder.
  3. Pancreas.
  4. Hilum of Kidneys.
  5. Duodenojejunal flexure.
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6
Q

How would you draw the transtubercular plane?

A

Joins the iliac crests of the pelvis.

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7
Q

What vertebral level is the transtubercular plane found at?

A

L4. (Same level as the bifurcation of the abdominal aorta).

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8
Q

What is the intercristal plane?

A

It joins the highest points of the pelvis at the back.

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9
Q

What vertebral level is the intercristal plane found at? Why is this important?

A

Between the L4 and L5 vertebrae. This is important for lumbar punctures and epidurals.

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10
Q

What is the subcostal plane and at what vertebral level does it lie?

A

It joins the lower points of the costal margins and lies at the L2 level.

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11
Q

What can the subcostal plane (L2) be a marker for?

A
  • The end of the spinal cord.
  • The superior mesenteric artery.
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12
Q

What is McBurney’s point?

A

2/3 of the way along a line extending from the umbilicus to the right anterior superior iliac spine.

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13
Q

What is the significance of McBurney’s point?

A

Marks the base of the appendix and can act as a guide for the location of the caecum.

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14
Q

Name the 3 flat muscles of the Abdominal wall.

A
  1. External Oblique.
  2. Internal Oblique.
  3. Transversus Abdominis.
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15
Q

In what direction do the fibres of the flat muscles run in?

A
  1. External oblique - inferiorly and medially (down and in).
  2. Internal oblique - superiorly and medially (up and in).
  3. Transversus abdominis - transversely.
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16
Q

What is the origin of external oblique?

A

Lower 8 ribs and thoraco-lumbar fascia.

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17
Q

What is the insertion of external oblique?

A

Pubic crest, pubic tubercle, iliac crest and linea alba.

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18
Q

What is the origin of internal oblique?

A

Thoraco-lumbar fascia, iliac crest, lateral 1/2 of the inguinal ligament.

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19
Q

What is the insertion of internal oblique?

A

Linea alba, pubic tubercle.

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20
Q

What is the origin of transversus abdominis?

A

Thoraco-lumbar fascia, iliac crest, lateral 1/3 of the inguinal ligament.

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21
Q

What is the insertion of transversus abdominis?

A

Linea alba, pubic tubercle.

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22
Q

What are the fibrous intersections of the rectus abdominis called?

A

Tendinous intersections.

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23
Q

What are the attachments of rectus abdominis?

A

Rectus sheath, pubis, costal cartilages.

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24
Q

Name 5 structures contained within the rectus sheath.

A
  1. Rectus Abdominis.
  2. Sup and inf epigastric arteries.
  3. Sup and inf epigastric veins.
  4. Nerves.
  5. Lymphatics.
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25
Q

What is the inferior epigastric artery a branch of?

A

The external iliac artery.

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26
Q

What is the internal thoracic artery a branch of? And what does it supply?

A

It is a branch of the subclavian artery and it supplies the anterior chest and abdominal wall and also the breasts.

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27
Q

Define dermatome.

A

An area of skin supplied by nerves from a single spinal root.

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28
Q

What are the dermatomes of the abdominal wall?

A

T7 to L1.

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29
Q

If a disease process involves the peritoneum of the abdominal wall, then the pain is localised. Why is this?

A

The peritoneum covering the inside of the abdominal wall has the same sensory nerve supply as the overlying skin.

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30
Q

What is the epithelium lining of the abdominal cavity?

A

Simple squamous epithelium.

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31
Q

Simple squamous epithelium.

A

A potential space between the visceral and parietal peritoneum. It is filled with peritoneal fluid.

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32
Q

What is a retroperitoneal organ?

A

An organ that only has it’s anterior surface covered by peritoneum. These organs lie behind the peritoneum.

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33
Q

Name 6 retroperitoneal organs.

A

Duodenum, ascending colon, descending colon, pancreas, oesophagus, kidneys. (DADPOK).

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34
Q

What is an intraperitoneal organ?

A

An organ fully covered in visceral peritoneum. It is suspended in the peritoneal cavity.

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35
Q

Name 6 intraperitoneal organs.

A

Sigmoid colon, appendix, liver, transverse colon, stomach, small intestine. (SALTSS).

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36
Q

What connects the lesser sac to the greater sac?

A

The epiploic foramen.

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37
Q

What does the lesser omentum attach to?

A

It extends from the liver and attaches to the lesser curvature of the stomach and the first part of the duodenum.

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38
Q

It extends from the liver and attaches to the lesser curvature of the stomach and the first part of the duodenum.

A
  • Common bile duct.
  • Hepatic artery.
  • Hepatic portal vein.
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39
Q

Where is attached to the greater curvature of the stomach?

A

The greater omentum.

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40
Q

Describe the position and folding of the greater omentum in the peritoneal cavity.

A

It hangs down like an apron and then folds back on itself meaning there are 4 layers. The posterior 2 layers go on to enclose the transverse colon (transverse mesocolon) and then form the parietal peritoneum of the posterior abdominal wall.

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41
Q

What is it called when the peritoneal cavity becomes distended by fluid?

A

Ascites.

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42
Q

With a patient in a supine (lying down) position, where might fluid collect in the abdomen?

A

In the right retrohepatic space.

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43
Q

What embryological structure forms the ligamentum teres?

A

The umbilical vein.

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44
Q

Which structures surround the epiploic foramen?

A
  • Anteriorly: lesser omentum.
  • Posteriorly: IVC.
  • Inferiorly: duodenum.
  • Superiorly: caudate lobe of liver.
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45
Q

What connects the jejunum to the posterior abdominal wall?

A

Small intestine mesentery.

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46
Q

What parts of the large intestine are intraperitoneal?

A

The transverse and sigmoid colon.

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47
Q

Define lesser sac.

A

A peritoneal sac that lies posteriorly to the stomach and lesser omentum. It communicates with the greater sac through the epiploic foramen.

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48
Q

What lies in the free border of the lesser omentum?

A

The hepatic artery, hepatic portal vein and common bile duct.

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49
Q

What structures lie posteriorly to the stomach?

A

Pancreas, diaphragm, splenic artery and vein.

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50
Q

Name the 4 main regions of the stomach.

A
  1. Cardia.
  2. Fundus.
  3. Body.
  4. Pylorus.
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51
Q

What vertebral levels does the stomach lie between?

A

T7 to L3.

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52
Q

What are the folds of the internal stomach surface called?

A

Rugae.

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53
Q

Name the 2 sphincters of the stomach.

A
  1. Inferior oesophageal sphincter.
  2. Pyloric sphincter.
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54
Q

Which sphincter of the stomach is physiological (containing no sphincteric muscle)?

A

The inferior oesophageal sphincter.

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55
Q

What forces act on the inferior oesophageal sphincter?

A
  1. The diaphragm exerts a pressure on the hiatus.
  2. The lumen is collapsed in the normal state.
  3. The oesophagus enters the stomach at a right angle; when the stomach is full this is closed off.
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56
Q

What is the function of the pyloric sphincter?

A

Controls the exit of chyme from the stomach.

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57
Q

What vertebral level is the coeliac trunk found?

A

T12.

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58
Q

Where does the foregut begin and end?

A

The mouth to the 2nd part of the duodenum (major duodenal papilla).

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59
Q

What is the blood supply to the greater curvature of the stomach?

A

The short gastrics, and the right and left gastro-epiploic arteries.

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60
Q

What is the blood supply to the lesser curvature of the stomach?

A

The left and right gastric arteries.

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61
Q

What is the right gastric artery a branch of?

A

The proper hepatic artery which arises from the common hepatic artery from the coeliac trunk.

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62
Q

What is the right gastro-epiploic artery a branch of?

A

It is the terminal branch of the gastroduodenal artery, this arises from the common hepatic artery which arises from the coeliac trunk.

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63
Q

What is the left gastro-epiploic artery a branch of?

A

The splenic artery which arises from the coeliac trunk.

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64
Q

What vein does venous blood from the GI tract, liver and spleen drain into?

A

The hepatic portal vein (goes to the liver).

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65
Q

What supplies sympathetic innervation to the stomach (foregut)?

A

The greater splanchnic nerve (T5-T9).

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66
Q

What supplies parasympathetic innervation to the stomach (foregut)?

A

The Vagus nerve Cn 10.

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67
Q

Is contraction of the stomach sphincters a sympathetic or parasympathetic action?

A

Sympathetic. (Parasympathetic = rest and digest).

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68
Q

At what vertebral level does the oesophagus pass through the stomach?

A

T10.

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69
Q

What structures pass through the diaphragm along side the oesophagus?

A

Vagus nerves and the oesophageal arteries and veins.

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70
Q

What does the left gastric artery supply?

A

The superior part of the lesser curvature of the stomach.

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71
Q

What structures lie anterior to the stomach?

A

The anterior abdominal wall and the left lobe of the liver.

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72
Q

What nerve lies anterior to the abdominal oesophagus and which posterior?

A

Left vagus - anterior.
Right vagus - posterior.
(LARP)

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73
Q

What are the 3 divisions of the small intestine called?

A
  1. Duodenum.
  2. Jejunum.
  3. Ileum.
74
Q

What is the principle function of the small intestine?

A

Digestion and absorption of food.

75
Q

What are the folds of mucosa inside the small intestine called?

A

Plicae circulares.

76
Q

What are Peyer’s patches?

A

Large, sub-mucosal, lymph nodules.

77
Q

Where in the small intestine would you find Peyer’s patches?

A

Ileum.

78
Q

Is the duodenum intraperitoneal or retroperitoneal?

A

Retroperitoneal.

79
Q

The first part of the duodenum is prone to peptic ulceration. What artery can this affect?

A

The gastro-duodenal artery. This artery lies in direct contact with the posterior wall of the first part of the duodenum.

80
Q

Would you describe the jejunum and ileum as intraperitoneal or retroperitoneal?

A

Intraperitoneal.

81
Q

What part(s) of the small intestine can become twisted? This results in strangulation and ischaemia.

A

Jejunum and ileum.

82
Q

Which has a thicker intestinal wall, the jejunum or the ileum?

A

Jejunum.

83
Q

Describe 5 characteristics of the Jejunum.

A
  1. Thick intestinal walls.
  2. Longer vasa recta.
  3. Less arterial arcades.
  4. Pronounced plicae circulares.
  5. Red in colour.
84
Q

Describe 5 characteristics of the Ileum.

A
  1. Thin intestinal walls.
  2. Shorter vasa recta.
  3. More arterial arcades.
  4. Peyer’s patches.
  5. Pink in colour.
85
Q

Where might you find Meckel’s diverticulum?

A

1 meter from the termination of the ileum.

86
Q

What is Meckel’s diverticulum an embryonic remnant of?

A

The attachment of the mid-gut to the yolk sac.

87
Q

Where does the mid-gut begin and end?

A

3rd part of duodenum to 2/3 along the transverse colon.

88
Q

What is the blood supply to the midgut?

A

Superior mesenteric artery (L1).

89
Q

What is the first branch of the SMA?

A

Inferior pancreaticoduodenal artery?

90
Q

Name 3 major branches of the SMA.

A
  1. Ileocolic.
  2. Right colic.
  3. Middle colic.
91
Q

What does the right colic artery supply?

A

The ascending colon.

92
Q

What does the middle colic artery supply?

A

The transverse colon.

93
Q

Into which vein does blood from the jejunum and ileum drain and what is the final destination of the blood?

A

Drains into the superior mesenteric vein.
This vein combines with the splenic vein to form the hepatic portal vein which then goes on to the liver.

94
Q

Which foodstuffs are absorbed through the lymphatic system?

A

Fats.

95
Q

What is the innervation of the small intestine?

A

Sympathetic: Lesser splanchnic (T10-11). Parasympathetic: Vagus. No somatic innervation.

96
Q

Name 4 mechanisms that ensure a high surface area for absorption of nutrients in the intestine.

A
  1. Pliae circularis.
  2. Coiled length.
  3. Villi.
  4. Microvilli.
97
Q

What is the main function of the large intestine?

A

Water absorption and the formation of faeces.

98
Q

State whether the caecum is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Intraperitoneal.
  • Ileocolic artery.
  • Ileocolic vein; drains into superior mesenteric vein.
99
Q

State whether the ascending colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Retroperitoneal.
  • Ileocolic and right colic arteries.
  • Ileocolic and right colic veins.
100
Q

State whether the transverse colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Intraperitoneal.
  • Middle colic artery.
  • Superior mesenteric vein.
101
Q

State whether the descending colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Retroperitoneal.
  • Left colic and superior sigmoid arteries.
  • Inferior mesenteric vein.
102
Q

State whether the sigmoid colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Intraperitoneal.
  • Sigmoid arteries.
  • Inferior mesenteric vein.
103
Q

What is the marginal artery of Drummond?

A

An artery that forms important anastomosis between SMA and IMA. It extends the length of the colon.

104
Q

What vertebral level is the inferior mesenteric artery found at?

A

L3.

105
Q

Name 3 characteristic features of the large intestine that allow it to be distinguished from other abdominal organs.

A
  1. Haustrations.
  2. Tenia coli.
  3. Appendices epiploicae.
106
Q

What are appendices epiploicae?

A

Small pouches of peritoneum filled with fat. They mark where blood vessels enter the bowel to supply the mucosa.

107
Q

What are tenia coli?

A

3 strips of longitudinally running muscle on the outer surface of the large intestine.

108
Q

What are haustrations?

A

Sacculations produced from where the tenia coli contract to shorten the wall of the bowel.

109
Q

Where does the hind gut begin and end?

A

Distal 1/3 of the transverse colon to the anal canal.

110
Q

What is the innervation of the hind gut?

A

Sympathetic: least splanchnic nerve (T12). Parasympathetic: S2-4. No somatic innervation.

111
Q

What artery normally supplies the descending colon?

A

The left colic artery.

112
Q

What is the importance of the marginal artery of Drummond?

A

If there is an occlusion to the IMA, blood can still be supplied to the large intestine via the SMA through this artery.

113
Q

Give 4 locations where the distal end of the appendix may lie.

A
  1. In the pouch of Douglas.
  2. Behind the caecum.
  3. Behind the umbilicus.
  4. Below the liver.
114
Q

Name the intraperitoneal parts of the large intestine.

A

Caecum, transverse colon, sigmoid colon.

115
Q

Give 4 functions of the liver.

A
  1. Synthesis of bile.
  2. Glycogen storage.
  3. Clotting factor production.
  4. Detoxification of blood.
116
Q

What is the liver an embryological derivative of and in which mesentery does it develop?

A

Derivative of the foregut. Develops in the ventral mesentery.

117
Q

What structure(s) lie anterior to the liver?

A

The rib cage and the anterior abdominal wall.

118
Q

What structure(s) lie superior to the liver?

A

The diaphragm.

119
Q

What structure(s) lie posterior to the liver?

A

Oesophagus, stomach, gall bladder, first part of duodenum. (All are foregut derived organs).

120
Q

What aspects of the liver does the diaphragmatic surface refer to?

A

The anterior superior aspects. This surface is smooth and convex.

121
Q

What aspects of the liver does the visceral surface refer to?

A

The posterior inferior aspects. It is moulded by the shape of surrounding organs and so is irregular.

122
Q

The posterior inferior aspects. It is moulded by the shape of surrounding organs and so is irregular.

A
  1. The falciform ligament.
  2. The right and left coronary ligaments.
  3. The right and left triangular ligaments.
123
Q

What is the function of the falciform ligament?

A

To attach the liver to the anterior abdominal wall.

124
Q

What is found in the free edge of this ligament?

A

The ligamentum teres (remnant of the umbilical vein).

125
Q

What is the function of the coronary and triangular ligaments?

A

They attach the superior surface of the diaphragm to the liver.

126
Q

Name the 4 lobes of the liver.

A
  1. Right.
  2. Left.
  3. Caudate.
  4. Quadrate.
127
Q

What structures bind the Caudate lobe and where is it located?

A

The IVC and a fossa produced by the ligamentum venosum. It is located on the upper aspect of the right lobe on the visceral surface.

128
Q

What structures bind the Quadrate lobe and where is it located?

A

The gall bladder and a fossa produced by the ligamentum teres. It is located on the lower aspect of the right lobe on the visceral surface.

129
Q

What divides the liver into the right and left lobes?

A

The falciform ligament.

130
Q

What vein supplies the liver with dexoygenated blood?

A

The hepatic portal vein.

131
Q

What vein supplies the liver with oxygenated blood?

A

The hepatic artery proper.

132
Q

What is the function of the gall bladder?

A

A temporary storage for bile.

133
Q

What is the storage capacity of the gall bladder?

A

30-50ml.

134
Q

What are the 3 divisions of the gall bladder?

A

Fundus, body and neck. The neck is where the gall bladder tapers and becomes continuous with the cystic duct.

135
Q

Briefly describe the biliary tree.

A

Left and right hepatic ducts = common hepatic duct.
Common hepatic duct + cystic duct = common bile duct. Common bile duct + pancreatic duct = hepatopancreatic ampulla of Vater.

136
Q

What is it called where the common bile duct and pancreatic duct meet?

A

The hepatopancreatic ampulla of Vater.

137
Q

What is the orifice called where bile empties into the duodenum?

A

The major duodenal papilla.

138
Q

What sphincter regulates the emptying of bile into the duodenum?

A

The sphincter of Oddi.

139
Q

What artery supplies blood to the gall bladder?

A

The cystic artery.

140
Q

Does parasympathetic or sympathetic innervation result in contraction of the gall bladder and the secretion of bile?

A

Parasympathetic.

141
Q

What is the arrangement anterior to posterior of the ducts, artery and portal vein at the porta hepatis?

A

Anterior: Common bile duct, hepatic artery, hepatic portal vein. (DAV)

142
Q

What is Calot’s triangle?

A

An anatomic space bounded by the liver superiorly, the cystic duct laterally and the common hepatic duct medially.

143
Q

What is the cystic artery a branch of?

A

The right hepatic artery - hepatic artery proper - common hepatic artery - coeliac trunk.

144
Q

Where is the bare area of the liver?

A

Under the tendinous part of the right hemi-diaphragm. This area has no peritoneal covering.

145
Q

What is the surface marking for the gall bladder?

A

The tip of the 9th costal cartilage. Where the lateral rectus sheath joins the costal margin.

146
Q

Where do the hepatic veins drain?

A

Into the IVC.

147
Q

What are the 3 major branches of the Coeliac trunk?

A

The left gastric, the splenic and the common hepatic.

148
Q

What does the left gastric artery supply?

A

The lesser curvature of the stomach and lower oesophagus.

149
Q

What branches does the splenic artery give off?

A
  • The short gastric arteries.
  • The pancreatic arteries.
  • The left gastroepiploic artery.
  • 5 branches just before it reaches the Spleen.
150
Q

What do the short gastric arteries supply?

A

The greater curvature of the stomach.

151
Q

What does the left gastroepiploic artery supply? What does anastomose with?

A

It supplies the greater curvature of the stomach. It anastomoses with the right gastroepiploic artery.

152
Q

Name the 2 branches of the common hepatic artery.

A
  1. Proper hepatic artery.
  2. Gastroduodenal artery.
153
Q

Name the 2 branches of the Gastroduodenal artery.

A
  1. Right gastroepiploic artery (supplies greater curvature of the stomach).
  2. Superior pancreaticoduodenal artery (supplies head of pancreas).
154
Q

Name the 3 branches of the proper hepatic artery?

A
  1. Right hepatic artery.
  2. Left hepatic artery.
  3. Right gastric artery.
155
Q

What does the right gastric artery supply?

A

The lesser curvature of the stomach.

156
Q

What is a branch of the right hepatic artery?

A

The cystic artery (supplies the gall bladder).

157
Q

Name the 4 divisions of the Duodenum.

A
  1. Superior.
  2. Descending.
  3. Inferior.
  4. Ascending.
158
Q

Where in the duodenum are ulcers most likely? And which artery would they affect?

A

Most likely in the superior duodenum (1st part). If the ulcers erode through the posterior wall they may effect the gastroduodenal artery and cause haemorrhage.

159
Q

What does the descending portion of the Duodenum lie posteriorly and anteriorly to?

A

Posteriorly to transverse colon. Anteriorly to the right kidney.

160
Q

What vessels lie anteriorly to the inferior part of the duodenum? (3rd part)

A

The superior mesenteric artery and vein.

161
Q

Is the duodenum retroperitoneal or intraperitoneal?

A

The duodenal cap is intraperitoneal but the rest of the duodenum is retroperitoneal.

162
Q

Is the pancreas retroperitoneal or intraperitoneal?

A

The tail is intraperitoneal but the rest of the pancreas is retroperitoneal.

163
Q

Name the 5 parts of the Pancreas.

A
  1. The head.
  2. The uncinate process.
  3. The neck.
  4. The body.
  5. The tail.
164
Q

What does the tail of the pancreas lie in close proximity to?

A

The hilum of the spleen.

165
Q

Why can diseases of the pancreas spread to adjacent tissues?

A

Because it isn’t contained within a capsule.

166
Q

What is the blood supply to the head of the pancreas?

A

The superior and inferior pancraticoduodenal arteries.

167
Q

What is the superior pancraticoduodenal artery a branch of?

A

The gastroduodenal artery.

168
Q

What is the inferior pancraticoduodenal artery a branch of?

A

The SMA.

169
Q

What is the blood supply to the rest of the pancreas?

A

Pancreatic branches of the splenic artery.

170
Q

What is the venous drainage of the pancreas?

A

The head drains into the SMV (drains into hepatic portal vein). the pancreatic veins drain the rest of the pancreas (these drain into the splenic vein).

171
Q

What is the function of the spleen?

A

In an adult it functions mainly as a blood filter, removing old RBC’s from circulation.

172
Q

Is the spleen intraperitoneal or retroperitoneal?

A

Intraperitoneal.

173
Q

What ligaments of the greater omentum connect the spleen to the stomach and kidney?

A

Gastrosplenic and Splenorenal.

174
Q

How far away is the major duodenal papilla from the pylorus of the stomach?

A

5cm.

175
Q

What is the embryological significance of the major duodenal papilla?

A

It marks the junction between the foregut and the midgut.

176
Q

What is the importance of the plicae circularis?

A

They increase the intestinal SA available for absorption.

177
Q

What is the dermatome of the umbilicus?

A

T10.

178
Q

You are examining a patient with a large spleen. How do you know on examination that you are palpating the spleen?

A
  • Located in the upper left quadrant.
  • Unable to feel an upper border on palpitation.
179
Q

Hypertrophy of the pyloric sphincter can cause what?

A

Vomiting of gastric contents.

180
Q

What is the appendicular artery a branch of?

A

The ileocolic artery (branch of SMA).

Medicine Phase 1 (16 decks)

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