Flashcards in GI Deck (91):
The process of chewing by movement of jaw and tongue
How many teeth are present in the grown adult?
What are the 4 types of teeth present in the mouth? From anterior to posterior
What number of tooth is where the parotid gland secretes through into the mouth
Upper tooth 7, molar 2
What are the four muscles of mastication?
The TMJ has two cavities for specific movements, what are these?
Superior cavity for translation
Inferior cavity for rotation
What are the three divisions of the trigeminal nerve? CN V
What is the attachment of CN V3 in the brain and the formamen it passes through to then supply what muscles?
Muscles of mastication
What are the four types of papillae on the tongue? Where are they located?
Vallate papillae (v shape) posterior part of tongue
Follate papillae (F far to the side)
Fungiform papillae ( middle of tongue)
Filiform (Fili like villi so touches food and senses temp, at tip of tongue)
What is the nerve supply to the tongue?
Posterior part CN IV (trochlear)
Anterior 2/3rd CN VII (facial
General sensation CN V3 (trigeminal mandibular)
Describe the course of the facial nerve from the brain to innervate the tongue
Attaches at the pontomedullary junction to then pass through the internal acoustic meatus then the sylomastoid foramen
It then bifurcates to become the chorda tympani and joins with CN V3 nerve to supply the submandibular salivary glands
Describe the innervation of the superior part of the oral cavity?
CN V2 trigeminal maxillary nerve
Describe the innervation of the inferior part of the oral cavity?
CN V3 trigeminal mandibular section
Spraying a local anesthetic in the mouth is to suppress the gag reflex for endoscope. What nerves does this block?
What is the course of the CN V2 nerve from the brain?
Through foramen rotundum
To sensory area (mid face)
Describe the course of the CN IX nerve (glossopharyngeal)
Supplying posterior wall of oropharynx
Parotid gland and posterior 1/3 of tongue
What are the three salivary glands and where do they secrete via
Parotid 2nd molar
Sublingual through floor of the mouth
Submandibular through the lingual carnucle
What nerves innervate the salivary glands
Parotid by the trochlear (CNIX)
Sublingual by facial nerve (CNVII)
Submandibular by facial nerve (CNVII)
What are the four pairs of skeletal muscles of the tongue? Working clockwise from roof of mouth to front of mouth
What are the skeletal muscles of the tongue innervated by ?
The hypoglossal nerve except from the palatoglossus
Describe the course of the hypoglossal nerve
Through hypoglossal canal
To extrinsic and intrinsic muscles of tongue
What nerves innervate the posterior part of the pharynx
The vagus nerve mainly and one muscle supplied by the glossopharyngeal CNIX
What is the vertebral level of the upper oesophageal sphincter?
The circular muscles of the pharynx all attach to what structure?
Describe the structures involved in the process of swallowing
Lips close to prevent drooling, orbicularis oris
Tongue pushes food towards oropharynx
Soft palate elevates and the larynx elevates
Circular layers of pharyngeal muscles contract
Food enters oesophagus and travels inferior by peristalysis
What structures are included in the foregut?
What structures are involved in the midgut?
2/3 transverse colon
What structures are involved in the hindgut?
Distal 1/3 of transverse colon
What muscles can be involved in guarding ?
What can cause peritonitis?
Faeces in the peritoneal cavity
What is an intraperitoneal organ?
One that is almost completely covered in visceral peritoneum so they are minimally mobile
What is an mesentery organ?
One that has a mesentery, where the visceral peritoneum wraps behind the organ to form a double layer, also known as intraperitoneal. Hence these are very mobile
What is a retroperitoneal organ?
One that only has visceral periotoneum on its anterior surface aka is behind the peritoneum
Give an example of an intraperitoneal organ
Liver and gall bladder
Some small intestines
Give some examples of retroperitoneal organs
What are the attachments of the greater omentum?
Attaches greater curvature of the stomach to the transverse colon
What are the attachments of the lesser omentum?
Lesser curvature of the stomach to liver with a free edge
What are the two most common causes of ascites?
Cirrhosis and portal hypertension
During paracentesis (abdominocentesis) [removal of fluid in abdominal cavity] where is the needle placed?
Lateral to the rectus sheath
What is the vertebral level of sympathetics to the abdominal organs?
Describe the course of the sympathetic nerves from the sympathetic chain to the organs
Exit the sympathetic chains within the abdominopelvic splanchnic nerves
To then synapse at prevertebral ganglia located anterior to the aorta to then become the periarterial plexus that then hitch a ride with arteries to innervate the muscles and glands of organs
What is the vertebral level of the sympathetics for the adrenal gland?
What is the vertebral level of the paraympathetic pelvic splanchnic nerves?
S2,3,4 keep the guts off the floor
If there is pain in foregut structures e.g stomach, liver, 1/2 pancreas, where does this pain tend to be felt?
In the epigastric region
If there is pain in midgut structures e.g duodenum, , 1/2 pancreas, transverse colon. where does this pain tend to be felt?
If there is pain in hindgut structures e.g distal 1/3 transverse colon, proximal 1/2 anal canal. where does this pain tend to be felt?
Visceral afferents of hindgut structures (nerves from organs going to cns) enter the spinal cord at what vertebral level?
Visceral afferents of MIDGUT structures (nerves from organs going to cns) enter the spinal cord at what vertebral level?
Visceral afferents of foregut structures (nerves from organs going to cns) enter the spinal cord at what vertebral level?
The body wall is supplied with somatic motor, sensory and sympathetic nerve fibres conveyed within the thoracoabdominal nerves that lie within the what?
7th-11th intercostal nerves, that then descend within the space between the internal oblique and transversus abdominis, to become the thoracoabdominal nerves
What causes jaundice?
An increase in the blood levels of bilirubin which is a bi-product of the degradation of RBCs mainly occuring in the spleen.
What is the function of bilirubin?
Used to form bile in the liver, important for the absorption of fats from the small intestine.
What are the four lobes of the liver?
What ligament separates the right and left lobes of the liver>
The falciform ligament
Why can increase in central venous pressure cause damage to the liver?
As the IVC and hepatic veins lack valves so any pressure travels backwards up to the liver
What vessels are within the portal triad?
Hepatic portal vein
Hepatic artery proper
What are the vessels that the coeliac trunk bifurcates into?
Left gastric artery
Common hepatic artery
What does the common hepatic artery from the coeliac trunk bifurcate into?
The hepatic artery proper (part of portal triad)
Superior pancreatic duodenal artery
At what vertebral level does the coeliac trunk come off the aorta
Describe the blood supply to the greater and lesser curvatures of the stomach and were these arteries bifurcated from
Lesser curvature; L. gastric artery from coeliac trunk anastamoses with the r. Gastric artery from the hepatic artery proper
Greater curvature; L. Gastro-omental from the splenic artery anastamoses with the r. Gastro-omental from the gastroduodenal artery
What are the arteries that supply the liver with oxygenated blood?
The right and left hepatic arteries which are branches from the hepatic artery proper (from the common hepatic artery of the coeliac trunk)
The liver is made of lobules, each lobule has a central vein with an interlobular triad at each corner. This contains a branch of the hepatic artery, branch of the hepatic portal vein and the hepatic nervous plexus. True or false?
The interlobular triad contains a branch of the hepatic artery, hepatic portal vein and a biliary duct.
What is the clinical relevance of the hepatorenal recess?
It is one of the lowest parts of the peritoneal cavity when patient is supine so fluid will collect here
What two veins converge to make the hepatic portal vein?
The splenic vein and the superior mesenteric vein
What is the function of the cystic duct?
To transport bile in and out of the gallbladder
What vessels make up the triangle of calot
Common hepatic duct
What is the vertebral level that visceral afferents from the gall bladder enter the spinal cord?
If someone is having gallbladder pain where will this present?
Early stages in the epigastric region
Also in the hypochondrium with/without pain referred to the right shoulder (due to irritation of the diaphragm
What is the function of the right and left hepatic ducts?
To transport bile from the liver to either the gall bladder for storage or to the duodenum
What are the four parts of the duodenum? Is this structure intra or retroperitoneal?
Superior (Duodenal cap) part 1
Horizontal (transverse) part 3
Ascending part 4
What peptide hormones does the duodenum secrete?
Gastrin (stimulating secretion of HCL)
CCK (stimulates the gallbladder to release bile to aid digestion of fat and proteins)
Name the four parts of the pancreas. Is this an intra or retroperitoneal organ?
The tail (near the left kidney and spleen)
Head (in curve of duodenum)
What are the two functions of the pancreas? What cells facilitate these functions?
Exocrine; secreating pancreatic digestive enzymes into main pancreatic duct from acinar cells
Endocrine; secreting insulin and glucagon into bloodstream from islets of langerhans
What is the ampulla of vater? What does it drain into? Through what papilla?
It is the convergence of the bile duct and the pancreatic duct. Which then secretes their contents into the duodenum via the major duodenal papilla
How is the drainage of bile controlled? By what structures?
By the use of sphincters
The bile duct sphincter on the bile duct
The pancreatic duct sphincter on the pancreatic duct
Sphincter of oddi on the ampulla of vater
What is ERCP ? What is it used for?
Used to study the bilary tree and pancreas
What can cause jaundice?
Obstruction of the biliary tree due to gall stones, carcinoma at the head of the pancreas (bit in the duodenal curve). Bile moves back up into the liver and can overspill into the blood (as bile is composed of bilirubin this can cause the yellowing)
What is the blood supply to the duodenum and pancreas ?
Gastroduodenal artery (formed from the common hepatic artery)
This then becomes the superior pancreaticoduodenal artery that anastamosis with the inferior pancreaticduodenal artery (formed from the superior mesenteric artery)
Splenic artery also supples the pancreas
What can cause pancreatitis?
Blockage of the ampulla of vater by a gallstone leading to backtracking of bile into the pancreas causing irritation and inflammation.
Where does pancreatic pain present?
Since pancreas foregut and midgut organ presents in the epigastric region and/ or the umbilical region
If pancreatitis goes untreated then vascular haemorrhage can occur. What clinical signs of this are there?
Grey-turners sign; large bruising on the right or left side of a patient
Cullens sign; bruising around the umbilicus
Where does the jejunum begin?
Begins at the duodenaljejunal flexure
Describe the paracolic gutters
Between the lateral edge of the ascending and descending colon, and abdominal wall
Part of greater sac of peritoneal cavity
Potential site for pus collection
What are some of the distinguishing features of colon
How are haustra formed?
By tonic contractions of the teniae coli
What is the usual position of the appendix?
What is Mcburneys point?
1/3 of the way between the right Anterior Superior Iliac Spine to the umbilicus
What is the anatomical position of the sigmoid colon
Left iliac fossa
What is the term for the twisting of the colon ?
What do the lateral branches of the abdominal aorta arrive?