GI Organs (Pt. 1) Flashcards
(182 cards)
1
Q
At what vertebral levels is the esophagus?
A
C6-T10
2
Q
At what vertebral level is the esophageal hiatus?
A
T10
3
Q
What is the opening of the esophagus into the stomach?
A
cardiac orifice
4
Q
In what abdominal quadrants is the stomach?
A
RUQ
LUQ
5
Q
At what vertebral levels is the entrance to the stomach? (Determine R or L)
A
T10-11 on the L
6
Q
At what vertebral level is the exit from the stomach? (Determine R or L)
A
L1 on the R
1.25 cm from midline
pylorus
transpyloric plane
7
Q
At what vertebral level is the entrance to the duodenum?
A
L1
entrance at pylorus
transpyloric plane
8
Q
At what vertebral level is the exit from the duodenum?
A
L2
duodenojejunal junction
9
Q
Is the first part of the duodenum intraperitoneal or retroperitoneal?
A
intra
10
Q
Are parts 2-4 of the duodenum intraperitoneal or retroperitoneal?
A
retro
11
Q
In what abdominal quadrant is the jejunum?
A
LUQ
12
Q
Is the jejunum intraperitoneal or retroperitoneal?
A
intra
13
Q
At what vertebral level is the entrance into the jejunum?
A
L2
duodenojejunal junction
14
Q
In what abdominal quadrant is the ileum?
A
RLQ
15
Q
Is the ileum intraperitoneal or retroperitoneal?
A
intra
16
Q
At what vertebral level is the exit from the ileum into the cecum?
A
L5
transtubercular plane
ileocecal junction
17
Q
is the cecum and appendix intraperitoneal or retroperitoneal?
A
intra
18
Q
What is the most common position of the appendix?
A
retrocecal
19
Q
In what abdominal quadrants is the ascending colon?
A
RLQ
RUQ
20
Q
Is the ascending colon intraperitoneal or retroperitoneal?
A
secondarily retro
21
Q
In what abdominal quadrants is the transverse colon?
A
RUQ
LUQ
22
Q
Is the transverse colon intraperitoneal or retroperitoneal?
A
intra
23
Q
At what vertebral level is the transverse colon?
A
L3
subcostal plane
24
Q
In what abdominal quadrants is the descending colon?
A
LUQ
LLQ
25
Is the descending colon intraperitoneal or retroperitoneal?
retro
26
In what abdominal quadrant is the sigmoid colon?
LLQ
27
At what vertebral level is the sigmoid colon?
S2
| interspinous plane
28
At what vertebral level does the sigmoid colon exit into the rectum?
S3
29
Is the sigmoid colon intraperitoneal or retroperitoneal?
intra
30
Is the rectum intraperitoneal or retroperitoneal?
retro
| within the pelvic cavity
31
What is the opening at the end of the rectum?
anus
32
Is the spleen intraperitoneal or retroperitoneal?
intra
33
In what abdominal region is the spleen?
left hypochondriac
34
What ribs are parallel and adjacent to the spleen?
9-11
35
At what sagittal line of the body is the spleen located?
along the mid-axillary line
36
Is the pancreas intraperitoneal or retroperitoneal?
retro
37
At what vertebral level is the pancreas?
L1
| transpyloric plane
38
In what abdominal quadrants is the pancreas?
RUQ
| LUQ
39
In what abdominal regions is the liver?
occupies most of the R hypochondriac region
upper epigastric
extends into L hypochondriac region
40
Is the liver intraperitoneal or retroperitoneal?
intra
41
Is the gallbladder intraperitoneal or retroperitoneal?
intra
42
In what abdominal quadrant is the gallbladder?
RUQ
43
At what vertebral level is the gallbladder?
L1
| transpyloric plane
44
What are the four constriction points of the esophagus?
- cervical constriction (cricopharyngeus M. at C6)
- thoracic constrictions
- -crossed by aortic arch and L main bronchus
- inferiorly through diaphragmatic sphincter
- -physiologic sphincter, not anatomic
45
What is the muscle composition of the esophagus?
- upper third = skeletal muscle
- middle third = mixed skeletal and smooth
- lower third = smooth muscle
46
What "structure" separates the esophagus from the fundus of the stomach?
cardiac notch
47
What are the four parts of the stomach?
cardia
fundus
body
pyloric part
48
What is the cardia of the stomach?
part surrounding the cardial orifice
49
What is the fundus of the stomach?
dilated, superior part that is related to the L dome of the diaphragm
50
What is the body of the stomach?
major part b/w fundus and the pyloric antrum
51
What is the pyloric part of the stomach?
antrum, pyloric canal, pylorus, pyloric orifice
52
What is the lesser curvature of the stomach?
- shorter, concave R border of the stomach
| - lesser omentum attaches to the lesser curvature
53
What point lies along the lesser curvature?
- angular incisure
| - -junction of the body and the pyloric part of stomach
54
What is the greater curvature of the stomach?
- longer, convex L border
| - greater omentum attaches to the greater curvature
55
What are gastric folds (rugae)?
-internal structures that form longitudinally during contractions
56
What is the gastric canal?
- forms b/w the gastric folds during swallowing
- along the lesser curvature
-saliva and small quantities of masticated foods and other fluids drain along canal when stomach is empty
57
What is the duodenum?
- 1st part of small intestine, shortest, widest
- from pylorus to duodenojejunal flexure
- consists of 4 parts
- -superior, descending, inferior, ascending
58
What is the importance of the second (descending) part of the duodenum?
- contains the major duodenal papilla
| - where bile and pancreatic juice are inserted
59
What is the importance of the fourth (ascending) part of the duodenum?
-Ligament of Treitz (suspensory muscle of the duodenum) attaches to the ascending part of the duodenum and widens the angle of the duodenojejunal flexure
60
What portions of the small intestines is comprised of the jejunum and the ileum?
```
jejunum = the first 2/5th
ileum = the last 3/5ths
```
61
What differs in the appearance of the ileum from the jejunum?
- the ileum is paler pink
- thinner walls
- lower and sparser plicae circulares
62
What is the structure where the ileum enters the cecum?
ileal papilla
63
Where does the ascending colon join the transverse colon?
hepatic (right) flexure
64
Which part of the colon is the longest and most mobile?
transverse
65
Where does the transverse colon meet the descending colon?
splenic (left) flexure
66
Which flexure is higher, right or left?
left (splenic) flexure is higher
67
What are the interior components of the rectum?
-superior, middle, and inferior transverse rectal folds
68
What are the differences b/w the internal and external anal sphincters?
- internal = smooth muscle, involuntary, parasympathetic control by pelvic splanchnic nn.
- external = skeletal muscle, voluntary, not under ANS control, controlled by somatic pudendal N.
69
What are internal structures of the anus?
```
anal columns
anal sinuses (with glands)
```
70
What is the pectinate line?
-divides the superior gut epithelium under the influence of visceral sensory nerves from the inferior skin epithelium under the influence of somatic sensory nerves
71
What are the two main surfaces of the spleen?
- diaphragmatic
- visceral
- -anterior (fundus of the stomach)
- -posterior (L suprarenal gland and kidney)
- -inferior (tail of pancreas and L colic flexure)
72
What are the five parts of the pancreas?
- head (lies in curvature of duodenum)
- body
- neck
- tail (adjacent to hilum of spleen, in splenorenal L.)
- uncinate process (superior to 3rd pt of duodenum)
73
What are the characteristics of the main pancreatic duct?
- begins in tail and courses toward the head
- joins common bile duct
-main pancreatic sphincter prevents bile from entering pancreas
74
What are characteristics of the accessory pancreatic duct?
-if it exists, it can open into the duodenum by itself in the minor duodenal papilla
75
What is the hepatopancreatic ampulla?
- union of the common bile duct w/main pancreatic duct
- Sphincter of Oddi
- enters duodenum at major duodenal papilla
76
What is the porta hepatis?
- transverse fissure on the visceral surface of liver
| - contains hepatic portal V., proper hepatic A., nerve plexus, bile ducts, and lymph vessels
77
What is contained within the L sagittal fissure?
-ligamentum teres from the falciform ligament
78
What is the R sagittal fissure?
- on the visceral surface
| - b/w the R and L functional lobes
79
What are the characteristics of the right lobe of the liver?
- larger
| - contains the caudate and quadrate lobes
80
What are the characteristics of the left lobe of the liver?
- smaller
| - contains the apex
81
How are the functional lobes of the liver determined?
-based on the division of the portal triad and blood supply
82
What comprises the R and L functional lobes of the liver?
R Liver = segments V through VIII
| L Liver = segments I through IV
83
What are the characteristics of liver segments?
- each segment has separate blood supply and a separate bile duct
- each segment is functionally independent of other segments
84
What do the R and L hepatic ducts form when they join?
common hepatic duct
85
What does the common hepatic duct join with and what do they form?
common hepatic duct joins the cystic duct to form the bile duct
86
What are the parts of the gallbladder?
- fundus
- body
- neck
87
What part of the gallbladder is attached to the cystic duct?
- neck
| - the cystic duct connects the neck of the gallbladder to the common hepatic duct to form the bile duct
88
How does the gallbladder keep the cystic duct open?
-the neck of the gallbladder spirals into a spiral fold which keeps the cystic duct patent
89
What are the relationships of the esophagus to other organs and structures?
- follows curvature of the vertebral column
- passes thru esophageal hiatus at R crus of diaphragm
- fits into groove on visceral surface of liver
90
What arteries supply blood to the esophagus?
- L gastric A. (from celiac trunk)
| - inferior phrenic A. (origin varies)
91
Into what lymph nodes does the esophagus drain?
left gastric LN's
92
What is the nerve supply to the esophagus?
- esophageal plexus of nerves
- - parasympathetics from vagal trunks
--sympathetics from thoracic sympathetic trunk via greater splanchnic nerve
93
What is the anterior border of the stomach?
- diaphragm
- L lobe of the liver
- abdominal wall
94
What is the posterior border of the stomach?
- lesser sac
| - pancreas
95
What is the inferolateral border of the stomach?
transverse colon
96
What comprises the bed of the stomach?
- L dome of the diaphragm
- spleen and splenic A.
- L kidney and suprarenal gland
- pancreas
- transverse mesocolon
97
What is the blood supply to the stomach?
- R and L gastric aa. along lesser curvature
- R and L gastro-omental aa. along greater curvature
-short gastric aa. and posterior gastric aa. supply fundus and upper body of stomach
98
What is the significance of the pre-pyloric vein?
- used by surgeons to identify the pylorus
| - ascends over pylorus to the R gastric vein
99
What lymph nodes drain the stomach?
- gastric LN's
- pyloric LN's
- pancreaticoduodenal LN's
100
What is the nerve supply to the stomach?
- parasympathetics from anterior and posterior vagal trunks (celiac plexus comes from the posterior)
- sympathetics from T6-T9 pass to the celiac plexus from the greater splanchnic N.
101
What is the relationship of the duodenum (big picture) to other organs and structures?
-duodenum makes a C-shape course around the head of the pancreas
102
What is the relationship of the 1st part of the duodenum to other organs and structures?
-superior part of the duodenum is overlapped by the liver and gallbladder
103
What is the relationship of the 2nd part of the duodenum to other organs and structures?
-hepatopancreatic ampulla enters on the posteromedial wall of the descending part (major duodenal papilla)
104
What is the relationship of the 3rd part of the duodenum to blood vessels?
- runs anterior to the aorta and IVC; posterior to the superior mesenteric vessels
- anterior to psoas major M. and the R testicular or ovarian vessels
105
What is the relationship of the 3rd part of the duodenum to "the mesentery"?
-beneath the root of the mesentery of the jejunum and ileum
106
What is the relationship of the 4th part of the duodenum to other organs and structures?
- ascending part runs along L side of the aorta
| - Ligament of Treitz (suspensory muscle of the duodenum) attaches to the duodenojejunal flexure here
107
What is the blood supply to the duodenum?
- gastroduodenal A.
- superior pancreaticoduodenal A.
- inferior pancreaticoduodenal A.
108
Where do the pancreaticoduodenal arteries lie?
- in the curve b/w the pancreas and the duodenum
| - the arteries supply both structures
109
What lymph nodes drain the duodenum?
- pancreaticoduodenal LN's
| - pyloric LN's
110
What is the nerve supply to the duodenum?
- parasympathetics from CNX
- sympathetics from greater and lesser splanchnic nn.
- celiac and superior mesenteric plexuses
- periarterial plexuses around the arteries
111
What is the blood supply to the jejunum?
- jejunal arteries off of the superior mesenteric A.
- arteries unite to form arterial arcades
- long vasa recta
112
What is the blood supply to the ileum?
- ileal arteries off of the superior mesenteric A.
- arteries unite to form arterial arcades
- short vasa recta
113
What lymph nodes drain the jejunum and ileum?
- juxtaintestinal LN's
| - -drain into the mesenteric LN's
114
What is the sympathetic nerve supply to the jejunum and ileum?
- sympathetics = T8-T10 sympathetic trunk via greater, lesser, and least splanchnic nn.
- superior mesenteric plexus
115
What is the parasympathetic nerve supply to the jejunum and ileum?
- posterior vagal trunk
- myenteric and submucosal plexuses
- -enteric nervous system in the intestinal wall
116
What is the relationship of the cecum and appendix to other organs and structures?
- in the iliac fossa about 2.5 cm from R inguinal L.
| - appendix is usually retrocecal
117
What the blood supply to the cecum and appendix?
- ileocolic A. (branch of SMA)
| - appendicular A. (branch of ileocolic A.)
118
What lymph nodes drain the cecum and appendix?
-ileocolic LN's
119
What is the nerve supply to the cecum and appendix?
- parasympathetics from vagus N.
- sympathetics from lower thoracic spinal cord
- superior mesenteric nerve plexus
120
What is the relationship of the ascending colon in relationship to other organs and structures?
-ascending colon is medial to the R paracolic gutter
121
What is the relationship of the transverse colon to other organs and structures?
-connected to posterior abdominal wall by transverse mesocolon
122
What is the relationship of the descending colon to other organs and structures?
- passes anterior to the lateral border of the L kidney
| - medial to the L paracolic gutter
123
What is the blood supply to the colon?
- ileocolic A., R colic A., and middle colic A. from SMA
| - L colic A. and sigmoid A. from IMA
124
What lymph nodes drain the colon?
- epicolic and paracolic LN's
- -drain to R, middle, and L colic LN's
- --drain to intermediate colic LN's
125
What is the nerve supply to the ascending and transverse colon?
- superior mesenteric nerve plexus
- -parasympathetics from vagus N.
- -sympathetics from lower thoracic spinal cord
126
What is the nerve supply to the descending and sigmoid colon?
- sympathetics from lumbar sympathetic trunk via lumbar splanchnic nn.
- parasympathetics from pelvic splanchnic nn.
127
What is the blood supply to the spleen?
splenic A. (largest branch of the celiac trunk)
128
What lymph nodes drain the spleen?
pancreaticosplenic LN's
129
What is the nerve supply to the spleen?
-celiac plexus (vasomotor) along the splenic A.
130
What is the relationship of the pancreas (big picture) to other organs and structures?
- posterior to the stomach
- b/w duodenum on the R and spleen on the L
- transverse mesocolon attaches to anterior margin
- main pancreatic duct runs from tail to head
- -meets w/ bile duct to form hepatopancreatic ampulla
131
What is the relationship of the head of the pancreas to other organs and structures?
- head of the pancreas lies within the curve of the duodenum
| - anterior to IVC
132
What is the relationship of the uncinate process to other organs and structures?
- extends medially to the L from the head of pancreas
| - posterior to SMA
133
What is the relationship of the neck of the pancreas to other organs and structures?
- anterior to superior mesenteric vessels
- posterior to pylorus of stomach
-behind the neck, the SMV joins the splenic V. to make the hepatic portal V.
134
What is the relationship of the body of the pancreas to other organs and structures?
- passes anterior to aorta
- anterior surface forms part of bed of stomach
-posterior surface in contact w/ aorta, SMA, L suprarenal gland, L kidney, and renal vessels
135
What is the relationship of the tail of the pancreas to other organs and structures?
- anterior to the L kidney
| - closely related to splenic hilum and L colic flexure
136
What is the blood supply to the pancreas?
- pancreatic branches of splenic A.
- anterior and posterior superior pancreaticoduodenal A.
- -from gastroduodenal A. (from common hepatic A.)
- anterior and posterior inferior pancreaticoduodenal A.
- -from superior mesenteric A.
137
What lymph nodes drain the pancreas?
- pancreaticosplenic LN's
| - pyloric LN's
138
What is the nerve supply to the pancreas?
- parasympathetics = CNX
- sympathetics = greater, lesser, and least splanchnic nn.
-pass along arteries from celiac plexus and superior mesenteric plexus
139
What are the relationships of the surfaces of the liver?
- diaphragmatic = direct contact w/ diaphragm (subphrenic recess) and IVC
- visceral = direct contact w/ gallbladder and IVC
140
How is the liver in contact with the stomach and duodenum?
- lesser omentum
- -hepatogastric L.
- -hepatoduodenal L.
141
Delineate the ducts beginning with the R and L hepatic ducts.
R + L hepatic ducts = common hepatic duct
common hepatic duct + cystic duct = bile duct
bile duct + pancreatic duct = hepatopancreatic ampulla
142
What structures have impressions on the visceral surface of the liver?
- R anterior of stomach and pylorus of stomach
- superior (first) part of duodenum
- gallbladder
- R colic flexure and R transverse colon
- R kidney and suprarenal gland
143
What is the blood supply to the liver?
- hepatic portal V. (75 percent)
| - proper hepatic A. (25 percent)
144
What drains the blood from the liver?
- R, intermediate (middle), and L hepatic V.
- -empty into IVC just inferior to diaphragm
- -help hold the liver in position
145
What lymph nodes drain the liver?
hepatic LN's
146
What is the nerve supply to the liver?
-hepatic plexus on branches of proper hepatic A. and hepatic portal V.
- sympathetics from celiac plexus
- parasympathetics from ant. and post. vagal trunks
147
What is the relationship of the bile duct to the superior part of the duodenum?
bile duct descends posterior to the superior part of the duodenum
148
What is the relationship of the bile duct to the pancreas?
- bile duct lies in a groove on the posterior surface of the head of the pancreas
- bile duct joins main pancreatic duct on L side of descending duodenum
149
What is the blood supply to the bile duct?
- cystic A. supplies proximal part of bile duct
- R hepatic A. supplies middle part of bile duct
-posterior superior pancreaticoduodenal A. and gastroduodenal A. supply retroduodenal part of duct
150
What lymph nodes drain the bile duct and gallbladder?
cystic LN's
LN of the omental foramen
hepatic LN's
151
What is the anatomical relationship of the gallbladder to the liver?
-gallbladder lies in the fossa b/w R and L parts of the liver in the R sagittal fissure
152
What is the anatomical relationship of the gallbladder to the superior part of the duodenum?
- the body of the gallbladder is immediately anterior to the superior part of the duodenum
- neck and cystic duct of the gallbladder is immediately superior to the superior part of the duodenum
153
What is the anatomical relationship b/w the gallbladder and the transverse colon?
body of the gallbladder is in contact with the transverse colon
154
What is the blood supply to the gallbladder?
-cystic A.
| from R hepatic A. off of the proper hepatic A.
155
What lymph nodes drain the gallbladder?
cystic LN's near the neck of the gallbladder
156
What is the nerve supply to the gallbladder?
celiac plexus along the cystic A.
- contains sympathetics and visceral afferent for pain
- contains parasympathetics from CNX
157
What is the significance of gallbladder inflammation and how those pain signals are transmitted?
-if gallbladder is inflamed, somatic afferent fibers of the R phrenic N. (C3-5) carry the pain signals
158
What is the phrenicoesophageal ligament?
attaches esophagus to the margins of esophageal hiatus
-permits independent mvmt of diaphragm during swallowing and respiration
159
What is the Ligament of Treitz (suspensory muscle of the duodenum)?
-from esophageal hiatus to duodenojejunal junction (enlarges the opening)
160
What are the four ligaments attached to the stomach?
- hepatogastric L.
- gastrophrenic L.
- gastrosplenic L.
- gastrocolic L.
161
What two ligaments are attached to the duodenum?
- hepatoduodenal L.
- Ligament of Treitz
- - aka suspensory muscle of the duodenum
162
What ligaments are attached to the jejunum and ileum?
- Ligament of Treitz
| - The Mesentery
163
What ligaments are attached to the large intestines?
- transverse colon
- -transverse mesocolon
- phrenicocolic L. (at left flexure)
-sigmoid mesocolon
164
What ligaments are attached to the spleen?
- gastrosplenic L.
- -attaches spleen to greater curvature
-splenorenal L.
connects hilum of the spleen to the L kidney
165
What ligament attaches to the anterior margin of the pancreas?
transverse mesocolon
166
What is the falciform ligament?
- in the L sagittal fissure on anterior surface
- separates R and L lobes of liver
- separates R and L subphrenic recesses
167
What is the ligamentum teres (aka round ligament of the liver)?
- remnant of umbilical vein
| - attached to the free edge of the falciform ligament
168
What is the coronary ligament?
- demarcates the bare area of the liver
| - anterior and posterior portions meet to form R and L triangular ligaments
169
What is the ligamentum venosum?
- in the L sagittal fissure on visceral surface
| - remnant of ductus venosus
170
What ligaments of the liver comprise the lesser omentum?
hepatogastric L.
| hepatoduodenal L.
171
What are the characteristics of the esophageal hiatus?
- located at T10 vertebral level
- elliptical opening in the R crus of the diaphragm
-muscular fiber crossings immediately inferior form the lower esophageal sphincter
172
What structures are transmitted through the esophageal hiatus?
- esophagus
- anterior and posterior vagal trunks
- esophageal branches of gastric vessels
- some lymphatic vessels
173
Who is at increased risk of hiatal hernias?
-increased risk after middle age d/t weakening of the diaphragm and widening of the esophageal hiatus
174
What are the characteristics of a para-esophageal hiatal hernia?
- less common
- no regurgitation bc cardial orifice is in normal position
-part of the fundus of the stomach extends through esophageal hiatus
175
What are the characteristics of a sliding hiatal hernia?
- part of the cardia and fundus of the stomach slide superiorly through esophageal hiatus
- some reflux/regurgitation is possible
176
What are some severe clinical implications of a gastric ulcer?
- if ulcer erodes a gastric A., patient may experience life-threatening bleeding
- posterior gastric ulcer may erode into pancreas or into splenic A. (causing a severe hemorrhage)
177
What bacterial infection is commonly associated with gastric ulcers?
Helicobacter pylori
-increased acid overwhelms the bicarb and decreases the effectiveness of protective mucus lining of stomach, thus making the stomach wall susceptible to infection by the bacteria and further damage by gastric acids
178
What is a vagotomy?
-a surgical section of the vagus N.
179
What is a truncal vagotomy?
denervates nerve supply to all of stomach plus most of the GI tract (parasympathetics by CNX stop prior to descending colon)
180
What is a proximal gastric vagotomy?
denervates branches of vagus only going to stomach
181
What is a selective proximal vagotomy?
specifically denervates areas in which the parietal cells are located, hoping to affect the acid-producing cells while sparing other gastric functions like motility
182
What are the characteristics of an ileal diverticulum?
- remnant of the omphalo-enteric duct (yolk sac)
- on the antimesenteric border of ileum
- finger-like pouch (free or attached to umbilicus)
- mostly ileal tissue, but can pancreatic, jejunal or colonic
- when inflamed, pain mimicks appendicitis
