lec15

Question 1

1. small instestine-duodenoum
   a. parts
   i. From the pylorus to duodenojejunal junction (flexure), the duodenum is about 10 inches long and consists of ___ parts.

ii. The 1st part (upper duodenal cap) is free, while the other parts are (_______).
ii. iThe hepatoduodenal ligament is attached to the ____ part of the duodenum.
2. Descending (2nd) part—receives ___ duct and _____ duct.
i. These come together at the hepatopancreatic ampulla, which opens at the _______.
3. Inferior (horizontal, 3rd) part—crosses anterior to the _____ and the ___.
4. Ascending (4th) part—connects with jejunum at the ____________

Answer 1

i. 4
ii. retroperitoneal (SAID PUCKER)
iii. first
2. bile and pancreatic
i. major duodenal papilla
3. aorta and IVC
4. major duodenal papilla

Question 2

1. small intestine- duodenum
   a. Major (greater) duodenal papilla—
   i. opening for the ____ and ____ ducts.
   ii. The opening of this papilla is guarded by the sphincter of the _______

Answer 2

i. bile and pancreatic

ii. the hepatopancreatic ampulla

Question 3

1. small intestine- duodenum
   a. Blood supply
   i. _____________arteries(from the celiac trunk) and _________
   ii. Venous drainage generally follows the arteries into the ____ venous system.
2. Nerves of the duodenum are from the sympathetic and parasympathetic nerves of the _______and ______ plexus

Answer 3

i. Pancreaticoduodenal , SMA
ii. portal
iii. celiac, superior mesenteric

Question 4

clinical correlate

when the stomach empties its contents, acid chyme is squirted against the anterolateral wall of the first part of the duodenum. This becomes an important factor in producing an ulcer at this site. Duodenal ulcers are more common than gastric ulcer

Answer 4

Duodenal ulcers

Question 5

II. SMALL INTESTINE—JEJUNUM AND ILEUM

A. About 20 feet long, the proximal 2/5 is _____ and the distal 3/5 is______.

B. Attached by the mesentery to the posterior abdominal wall, which permits entrance and exit of branches of the superior mesenteric ____

C. Blood supply—branches (jejunal and ileal) of the superior mesenteric artery. ==> ___________

D. The_________ drains the jejunum and ileum.

E._____—vessels within the intestinal wall empty into plexuses within the intestinal wall, then into larger vessels. ______ drains into the mesenteric group of lymph nodes, and ultimately into the thoracic duct. This is the route taken by _____. Other nutrients pass into the _____.

F. The nerves of the jejunum and ileum are derived from the ____ and ______ nerves through the celiac ganglion and the nerve plexus around the superior mesenteric artery.

G. In about 2% of the population, a diverticulum in the ileum (________) is present as an outpouching of the intestinal wall—a persistence of the omphalomesenteric duct of the embryo. This is a common cause of _____________.

Answer 5

A. jejunum, ileum

B. VAN

C. intestinal artery

D. SMV

E. lymphatics, lymph, digested fat, portal vein,

F. vagus and greater sphlanic

g. Meckel’s diverticulum, intestinal bleeding

Question 6

III. LARGE INTESTINE
i.The primary function of the large intestine is the absorption of ____ and _____ and the storage of ____ ____until it can be excreted as feces.

ii. The large intestine forms an arch for the coils of the small intestine. In addition to its larger diameter, it can be distinguished from the small intestine by: 1) ____, 2)______, 3)_____
iii. Cecum—the part that lies _____ the level of the junction of the ileum with the large intestine. It has a considerable amount of mobility, even though it does not have a mesentery.
1. ______—a narrow blind tube that joins the cecum about one inch below the ileocecal opening. It has a short mesentery of its own, the mesoappendix, and has a considerable range of movement.
2. However, the base of the appendix is fairly constant at _____—1/3 of the distance from the right anterior superior iliac spine to the umbilicus.
3. ______—at the end of the ileum at the junction of the cecum with the colon. The ileocecal valve is only partly functional.
4. _______—extends upward from the cecum to the right colic flexure. Peritoneum covers the front and sides (i.e., it is retroperitoneal)

Answer 6

i. water and electrolytes, undigested material
ii. 1)teniae coli, three thickened bands of longitudinal muscle; 2) haustra, sacculations of its wall; and 3) appendices epiploicae, pouches of peritoneum filled with fat.
iii. below
1. below
2. McBurney’s Point
3. Ileocecal valve
4. Ascending colon

Question 7

III. LARGE INTESTINE cont.

5. _______—begins at the right colic (hepatic) flexure, is suspended by the transverse mesocolon, and extends to the left colic flexure.
6. ___________—attaches left colic flexure to the diaphragm. The transverse mesocolon is attached to its superior border.
7. _______—passes inferiorly from the left colic (splenic) flexure to the brim of the pelvis where it becomes continuous with the sigmoid colon at the level of the inguinal ligament. Like the ascending colon it is retroperitoneal—covered with parietal peritoneum where it is not in direct contact with the posterior abdominal wall.
8. ___________—extends from the iliac fossa to the 3rd sacral vertebra. It lies within the pelvis, suspended from its wall by the sigmoid mesocolon, and has considerable freedom of movement
9. Rectum and anus

Answer 7

5. Transverse colon
6. Phrenicocolic ligament
7. Descending colon
8. Sigmoid colon
9. rectum and anus

Question 8

III. LARGE INTESTINE cont.

1. Blood supply
   a. Ileocolic and right colic branches of the superior mesenteric artery to the ascending colon and cecum.
2. Middle colic branch of the superior mesenteric artery to the transverse colon.
3. Left colic branch of the inferior mesenteric artery to the descending colon.
4. Sigmoid branch of the inferior mesenteric artery to the sigmoid colon.
5. Superior rectal artery—the terminal branch of the inferior mesenteric artery—to the rectum.
6. ________—anastomosis of the colic arteries around the margin of the large intestine.

Answer 8

6. Marginal artery

Question 9

III. LARGE INTESTINE cont.

Clinical Conditions

1. __________—inflammation of the appendix. This is usually caused by obstruction of the appendix, most often by fecal material.
2. Ulcerative colitis—a chronic disease of the colon characterized by severe inflammation and ulceration of the colon and rectum

Answer 9

1. Appendicitis

2. Ulcerative colitis