Lecture 6 Flashcards
(126 cards)
1
Q
What comes off the abdominal aorta at the T12 level?
A
Coeliac Trunk.
2
Q
What comes off the Coeliac trunk?
A
Left.Gastric artery.
Splenic artery.
Common Hepatic artery.
3
Q
What comes off the abdominal aorta at the L1 level?
A
Superior Mesenteric artery.
4
Q
What comes off the abdominal aorta at the L3 level?
A
Inferior Mesenteric artery.
5
Q
What comes off the abdominal aorta at the L4 level?
A
Right and Left Common Iliac artery.
6
Q
What structures are apart of the foregut?
A
Distal 1/2 Oesophagus. Stomach. Pancreas. Liver. Biliary Apparatus. Proximal 1/2 Duodenum.
7
Q
What is the arterial supply of the foregut?
A
Branches of the Coeliac axis (Abdominal aorta at T12).
8
Q
What is the venous drainage of the foregut?
A
Portal vein.
9
Q
What is the nerve supply of the foregut?
A
Coeliac Plexus at T12.
10
Q
What are the lymphatics of the foregut?
A
Pre-aortic nodes at T12 (called coeliac nodes).
11
Q
What is the pain referred to in the foregut?
A
Epigastric region.
12
Q
What is the general region of the stomach (surface anatomy)?
A
Epigastric (to the left of the midline).
13
Q
Where is the fundus (surface anatomy)?
A
Rib 5/6.
14
Q
Where is the oesophagus (surface anatomy)?
A
Costal cartilage 7/8.
15
Q
Where is the pylorus (surface anatomy)?
A
L1 vertebral level.
16
Q
How many layers are in the muscularis externa of the stomach?
A
There are three.
Outer = longitudinal.
Middle = Circular.
Oblique = Inner.
17
Q
What lines the inner wall of the muscularis externa?
A
Rug. These increase the surface area.
18
Q
What are the three parts of the stomach?
A
Fundus.
Body.
Pylorus.
19
Q
What arteries supply the lesser curvature of the stomach?
A
Left Gastric and Right Gastric.
20
Q
What does the left gastric artery branch off from?
A
Coeliac trunk.
21
Q
What does the right gastric artery branch off from?
A
Common Hepatic.
22
Q
What arteries supply the greater curvature of the stomach?
A
Left Gastro-omental and Right Gastro-omental.
23
Q
What does the left gastro-omental artery branch off from?
A
Splenic artery.
24
Q
What does the right gastro-omental artery branch off from?
A
Gasproduodenal which branches off from the Common Hepatic artery.
25
What is tricophagia?
It is a psychological condition of eating hair - it is associated with trichotillomania (pulling out hair).
If enough hair is ingested a hair ball can form - trichobezoar.
26
What can tricophagia cause?
Indigestion and stomach pain.
27
Where does the duodenum originate?
Immediately following the pyloric region of the stomach.
28
Where is the 1st part of the duodenum?
It is in the Transpyloric Plane (L1) it is superior.
29
Describe the 1st part (in terms of peritoneum)?
It is intraperitoneal.
30
Where is the 2nd part of the duodenum ?
It wraps around the head of the pancreas. It is on the right hand side of the midline, and it is descending.
31
Describe the 2nd part (in terms of peritoneum)?
It is retroperitoneal.
32
Where is the 3rd part of the duodenum?
It crosses back over the Inferior Vena Cava (IVC) and the Aorta. It is inferior.
33
Describe the 3rd part (in terms of peritoneum)?
It is retroperitoneal.
34
Where is the 4th part of the duodenum?
It ascends to the Duodenojejunal flexure, which is on the left hand side of the midline. It is ascending.
35
Describe the 4th part (in terms of peritoneum)?
Retroperitoneal.
36
What happens halfway along the duodenum?
The foregut transitions to the midgut. The blood, nerves and lymphatics change.
37
What artery supplies the superior half of the duodenum?
Superior Pancreatoduodenal branches. These come from the Gasproduodenal artery, which comes from the Common Hepatic artery which comes form the Coeliac trunk.
38
What artery supplies the inferior half of the duodenum?
Inferior Pancreatoduodenal branches. These come from the Superior Mesenteric Origin.
39
What is the ANS nervous supply for the superior half of the duodenum?
Coeliac Plexus at T12.
40
What is the ANS nervous supply for the inferior half of the duodenum?
Superior Mesenteric Plexus at L1.
41
What is the venous drainage of the superior half of the duodenum?
Direct to the Portal Vein.
42
What is the venous drainage of the inferior half of the duodenum?
Superior Mesenteric vein (SMV).
43
What is the lymphatic drainage of the superior half of the duodenum?
Pre-aortic coeliac nodes at T12.
44
What is the lymphatic drainage of the inferior half of the duodenum?
Pre-aortic Superior Mesenteric nodes at L1.
45
What is the Ampulla of Vater?
Union of Common Bile Duct and Main Pancreatic Duct.
46
Where does the Major Duodenal Papilla enter?
Through the wall of the Descending Duodenum (2nd Part).
47
What does the Major Duodenal Papilla control?
The flow of bile (from the liver) and pancreatic juice (from the pancreas) into the duodenum via the Sphincter of Oddi.
48
What are the structures of the midgut?
```
Distal 1/2 of duodenum.
Jejunum.
Ileum.
Caecum and Appendix.
Ascending colon.
2/3 Transverse colon.
```
49
What is the arterial supply of the midgut?
Branches of Superior Mesenteric artery. Abdominal aorta at L1.
50
What is the venous drainage of the midgut?
Superior Mesenteric Vein.
51
What is the nervous supply of the midgut?
Superior Mesenteric Plexus, at L1.
52
What is the lymphatic drainage of the midgut?
Pre-aortic Superior Mesenteric nodes at L1
53
How long is the small intestine?
6m long.
54
What occurs at the small intestine?
Majority of digestion.
55
The small intestine is converted into what parts?
Jejunum (proximally):
-2/5 of the small intestine length.
Ileum (distally):
-3/5 of the small intestine length.
56
What is the small intestine suspended by?
It is suspended from the body wall via a mesentery.
57
Describe the mesentery?
It is a fan-shaped folds of peritoneum which enclose the gut tube. It allows for ingress/egress of vessels, nerves and lymphatics.
58
Describe the arterial arcade patterning in the Jejunem?
1 or 2 arcades with long branches.
59
Describe the arterial arcade patterning in the Ileium?
More arcades with many short branches.
60
Where does the transition occur from Midgut to Hindgut?
2/3 along the Transverse Colon.
61
What are the parts of the Large intestine?
[From midgut to hindgut]:
```
*Appendix.
Caecum.
Ascending Colon.
Hepatic Flexure.
Transverse Colon.
Splenic Flexure.
Descending Colon.
Sigmoid Colon.
```
62
What is pain referred to in the Large intestine?
```
Midgut = Umbilical region.
Hindgut = Suprapubic.
```
63
What is the function of the Large Intestine?
Absorb water and electrolytes.
| Store undigested material until expelled by the body.
64
What are the Haustra?
Sacculations of the wall.
65
What are the appendices epiploicae?
Fatty tags.
66
What are the Teniae Coli?
Longitudinal muscles collected into 3 bands (continuous with smooth muscle of small intestine).
67
Where is the large intestine found in the surface anatomy?
All regions except umbilical.
68
Where is the caecum/appendix (in terms of surface anatomy)?
Right groin.
69
Where is the Hepatic flexure (in terms of surface anatomy)?
Right hypochondrium. Inferior to the liver.
70
Where is the Splenic flexure (in terms of surface anatomy)?
Left hypochondriac. Anterior to the spleen.
71
Where is the Sigmoid colon (in terms of surface anatomy)?
Left groin.
72
What is the arterial supply for the caecum/appendix?
Caecal and Appendicular arteries.
73
Where do Caecal and Appendicular arteries branch from?
Ileocolic artery.
74
What is the arterial supply for the ascending colon?
Right Colic artery.
75
What is the arterial supply for the proximal 2/3 Transverse colon?
Middle Colic and Marginal artery.
76
What does the Superior Mesenteric Artery form?
Caecal and Appendicular arteries.
Right Colic artery.
Middle Colic and Marginal artery.
77
What is the arterial supply for the distal 1/3 Transverse colon?
Marginal and Left Colic artery.
78
What is the arterial supply for the descending colon?
Left Colic artery.
79
What is the arterial supply for the sigmoid colon?
Sigmoid artery.
80
What is the significance about the marginal artery?
It is the anastomotic point between Superior and inferior Mesenteric arteries.
81
Arterial supply of the midgut?
Branches of Superior Mesenteric artery, at L1.
82
ANS Nervous supply of the midgut?
Superior Mesenteric Plexus, at L1.
83
Venous drainage of the the midgut?
Superior Mesenteric Vein.
84
Lymphatic drainage of the midgut?
Pre-aortic superior mesenteric nodes at L1.
85
Arterial supply of the hindgut?
Branches of Inferior Mesenteric artery, at L3.
86
ANS Nervous supply of the hindgut?
Inferior Mesenteric Plexus, at L3.
87
Venous drainage of the hindgut?
Inferior Mesenteric Vein.
88
Lymphatic drainage of the hindgut?
Pre-aortic inferior mesenteric nodes, at L3.
89
When does the sigmoid colon become the rectum?
S3 vertebral level.
90
Where does the rectum go?
It pierces the pelvic diaphragm (at the tip of the coccyx) to become the anal canal.
91
Describe the superior 1/3 of the Rectum (in terms of peritoneum)?
Covered in visceral peritoneum.
92
Describe the middle 1/3 of the Rectum (in terms of peritoneum)?
Peritoneum on the anterior surface only.
93
Describe the inferior 1/3 of the Rectum (in terms of peritoneum)?
Infra peritoneal.
94
What is the arterial supply of the superior 1/3 of the rectum?
Superior rectal branches of Inferior Mesenteric Artery (at L3).
95
What is the arterial supply of the middle 1/3 of the rectum?
Middle rectal branch of Internal Iliac artery.
96
What is the arterial supply of the inferior 1/3 of the rectum?
Inferior rectal branch of the Internal Pudendal.
97
What is the ANS nervous supply of the proximal 1/3 of the rectum?
Inferior Mesenteric Plexus at L3.
98
What is the ANS nervous supply of the distal 2/3 of the rectum?
Inferior Hypogastric Plexus.
99
What is the lymphatic drainage of the proximal 1/3 of the rectum?
Pre-aortic nodes at L3.
100
What is the lymphatic drainage of the distal 2/3 of the rectum?
Internal iliac nodes.
101
What is the venous drainage of the superior 1/3 of the rectum?
Superior rectal vein.
102
Where do the superior rectal veins one from?
Inferior Mesenteric Vein, which comes from splenic vein, which comes from the portal vein.
103
What is the venous drainage of the middle 1/3 of the rectum?
Middle Rectal vein.
104
Where does the middle rectal vein come from?
Internal iliac, which comes from Common iliac which comes from Inferior Vena Cava.
105
What is the venous drainage of the inferior 1/3 of the rectum?
Inferior rectal vein.
106
Where does the inferior rectal vein come from?
Internal iliac, which comes from Common iliac which comes from Inferior Vena Cava.
107
Describe the portal venous system?
Superior Mesenteric Vein goes directly to the Portal vein; inferior mesenteric vein goes to the splenic vein which goes to the portal vein. Portal vein goes to the Liver.
108
Where is portal vein formed at?
L1 - Trans-pyloric plane.
109
What does the Parasympathetic system supply to the gut?
Vagus nerve (CN X) and Pelvic Splanchnic nerves S2-4.
110
What does the Sympathetic system supply to the gut?
Thoracic, lumbar and sacral splanchnic nerves (from T5-L2 sympathetic ganglia).
111
What does the ANS control in the gut?
Viscera, glans, blood vessels.
Smooth muscle.
Non-conscious control.
Motor and sensory.
112
Describe the ANS to the foregut?
```
Plexus = Coeliac.
Sympathetic = Greater Splanchnic (T5-T9).
Parasympathetic = Vagus [X].
```
113
Describe the ANS to the midgut?
```
Plexus = Superior Mesenteric.
Sympathetic = Lesser splanchnic (T10-T11).
Parasympathetic = Vagus [X].
```
114
Describe the ANS to the aorticorenal?
```
Plexus = Renal.
Sympathetic = Least splanchnic (T12).
Parasympathetic = Vagus [X].
```
115
Describe the ANS to the hindgut?
```
Plexus = Inferior Mesenteric/Superior Hypogastric.
Sympathetic = Lumbar/Sacral splanchnic (L1&2/S2-4).
Parasympathetic = S2-S4.
```
116
Describe the AND to the pelvic organs?
```
Plexus = Inferior/Superior Hypogastric.
Sympathetic = Sacral splanchnic (S2-S4).
Parasympathetic = Pelvic splanchnic (S2-S4).
```
117
Where is pain referred to?
Back to the origin spinal levels of the sympathetic supply via afferent fibres and then via the dorsal root.
118
Is there is a specific pain reference?
No there isn't, so pain is spread around the corresponding dermatome.
119
Where is pain referred to in the foregut region?
Epigastric region.
| T5-T9 (Greater splanchnic).
120
Where is pain referred to in the midgut region?
Umbilical region.
| T10-T11 (Lesser splanchnic).
121
Where is pain referred to in the hindgut region?
Suprapubic region.
| L1/L2 (Lumbar/Sacral splanchnic).
122
What happens in an appendicitis?
The appendix becomes enflamed.
123
Where does the pain refer back to in an appendicitis?
The afferent sympathetic fibres refer back to T10-T11 dermatomes.
124
Where is pain experienced?
The broad diffuse pain is experienced around the umbilical region.
125
What happens when appendix becomes more enflamed?
The appendix starts to press on the parietal peritoneum of the body wall - this is known as somatic sensory supply.
126
Where is pain felt after the appendix is enflamed?
It is felt as acute and localised int he lower right quadrant.
