Midgut Anatomy Flashcards

(62 cards)

1
Q

What are the two organs of the midgut?

A
  1. small intestine: (Distal 1/2 of the duodenum, jejunum, ileum)
  2. Two thirds of the large intestine: (Cecum, appendix, ascending colon, transverse colon
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2
Q

Is the transverse colon anterior or posterior?

A

Anterior; it can be seen from an anterior view of the stomach without the greater omentum removed.

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3
Q

When you open the abdominal wall, what cavity are you peering into?

A

peritoneal cavity

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4
Q

When you open the abdominal wall, what sac are you peering into? Greater or lesser?

A

Greater sac

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5
Q

In order to view the last portion of the duodenum, what portions of the small intestine need to be removed?

A

Jejunum and ileum

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6
Q

Which trunk of the aorta serves the midgut?

A

Superior mesenteric artery

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7
Q

What plexus innervates the organs of the midgut?

A

superior mesenteric plexus (pre-aortic plexus)

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8
Q

What are the most anterior structures of the midgut?

A
  1. transverse colon
  2. jejunum
  3. ileum
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9
Q

The ascending colon is (anterior/posterior).

A

posterior; however sometimes the ileum and jejunum are found behind the ascending colon

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10
Q

The duodenum is (anterior/posterior) to the jejunum and ileum.

A

posterior

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11
Q

What organ of the midgut is just anterior to the aorta and the inferior vena cava?

A

Duodenum

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12
Q

What other organ is snuggled in the curvature of the duodenum?

A

pancreas

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13
Q

On an axial CT or MRI image through an approximate L3, list the location of the midgut organs from most posterior to most anterior.

A

Anterior: Transverse colon, ileum, jejunum, ascending colon, duodenum

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14
Q

What is the name of the ligament that secures the duodenum to the esophagus?

A

suspensory ligament

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15
Q

When the suspensory ligament is covered by peritoneum, what structure does it form?

A

the Ligament of Treitz

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16
Q

The majority of the duodenum is retroperitorneal/peritoneal?

A

Retroperitoneal; only parts 2 and 3 have peritoneum draping over the organ. It is not surrounded.

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17
Q

Which mesentery attaches the ileum and jejunum to the posterior abdominal wall?

A

The Mesentery

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18
Q

Are the jejunum and ileum peritoneal or retroperitoneal?

A

Both are peritoneal; they are completely covered by peritoneum and attached to the posterior abdominal wall by The Mesentery.

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19
Q

Which is slightly larger in caliber (diameter), the jejunum or the ileum?

A

The jejunum has a slightly larger caliber.

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20
Q

Which is longer the jejunum or ileum?

A

the ileum (14ft long), the jejunum is only 9ft long.

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21
Q

Which has more folds, the jejunum or ileum?

A

Jejunum

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22
Q

List differences between the jejunum and ileum.

A

Ileum:

  • Longer (12 ft)
  • smaller caliber
  • less folds
  • shorter vasa recta
  • less metabolic activity
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23
Q

Which has longer straight vasa recta, the jejunum or the ileum?

A

Jejunum

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24
Q

Which portion of the small intestine has higher metabolic activity?

A

Jejunum, thus it has more folds to increase absorptive surface and a more direct artery supply.

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25
What valve connects the ileum to the cecum?
ileocecal valve in the ileocecal junction, formed by the ileocecal sphincter.
26
Is the cecum peritoneal or retroperitoneal?
The cecum is completely covered by peritoneum and is thus peritoneal.
27
Where is the appendix?
It hangs from the cecum.
28
What is the lymphoid structure that hangs from the cecum?
appendix
29
Is the appendix retroperitoneal or peritoneal?
peritoneal; it is completely surrounded and is supplied by the mesoappendix.
30
Why do patients with appendicitis usually experience pain in dermatome T10?
referred pain
31
Can the appendix be found in multiple places?
Yes, the appendix can be found in multiple positions with respect to the cecum. The most common are retrocecal and pelvic.
32
What is the name of the junction between the ascending colon and the transverse colon?
The hepatic flexure or right colic flexure
33
What is the function of haustrum (pl: haustra)?
sacculation
34
What are epiploic appendages?
small sacs filled with fat; they are for fat storage
35
What type of muscle is tenia coli, where would you find them in the body?
smooth muscle thickenings, found on the surface of the colon as longitudinal ribbons
36
How is the transverse colon attached to the posterior abdominal wall?
by its mesentery, the transverse mesocolon
37
Is the ascending colon peritoneal or retroperitoneal?
retroperitoneal
38
Is the transverse colon peritoneal or retroperitoneal?
peritoneal
39
Retroperitoneal or peritoneal? - Cecum - Ascending colon
Cecum: peritoneal; the peritoneum covering the ileum completely covers the cecum Ascending colon: retroperitoneal; the peritoneum is draped on the top, but does not cover this structure.
40
What 3 additional features distinguish the colon from the small intestine?
1. tenia coli 2. epiploic appendages 3. haustrum
41
The aorta has 3 major unpaired trunks. Name them.
1. Celiac trunk 2. Superior Mesenteric Artery 3. Inferior Mesenteric Artery
42
List the major branches of the superior mesenteric artery.
1. intestinal branches (12-18) 2. middle colic artery 3. ileocecal artery 4. Right colic artery
43
What portion of the large intestine does the middle colic artery serve?
Transverse colon
44
What portion of the small intestine do the intestinal branches serve?
the jejunum and ileum
45
What portion of the large intestine does the ileocecal artery serve?
ileocolic region
46
What 3 structures or regions are served by the right colic artery?
1. ascending colon 2. hepatic flexure 3. transverse colon
47
The beginning of the superior mesenteric artery is posterior to what organ?
pancreas
48
To gain access to the superior mesenteric artery during surgery what structures would you have to cut through using an anterior abdominal approach?
1. skin 2. Abdominal wall muscles 3. parietal peritoneum 4. Stomach 5. pancreas 6 finally the SMA
49
What two blood vessels "sandwich" the duodenum?
1. superior mesenteric artery | 2. aorta
50
If you had to use an anterior approach to access the superior mesenteric artery, list the organs you would pierce.
SAPSPS 1. skin 2. abdominal wall muscles 3. Parietal peritoneum-peritoneal cavity-visceral peritoneum 4. stomach 5. pancreas 6. SMA
51
The portal vein is formed by the combination of which two veins?
1. splenic vein | 2. superior mesenteric vein
52
Which is a tributary to the IVC, (portal vein/hepatic vein/superior mesenteric artery)
the hepatic vein is a tributary to the IVC. Blood from the gut enters the portal vein & travels through the liver to the hepatic veins which are tributaries to the IVC.
53
What organ is found immediately anterior to the SMA at the point where it branches from the aorta?
pancreas
54
The SMA projects slightly anteriorly, from its root on the aorta. When we see it emerging anteriorly, it is between which two organs?
pancreas and the duodenum
55
What is the name of the smaller ganglia flanking the superior mesenteric ganglion?
aorticorenal ganglia
56
What type of fibers might you find in the superior mesenteric artery?
1. motor fibers carrying movement orders from the CNS to the organ 1a. para/pre from vagus 1b. symp/pre from thoracic & lumbar splanchnic 1c. symp/post 2. sensory fibers carrying sensor stimuli from the organ to the CNS
57
List the verterbral levels in which you would find cell bodies of thoracic splanchic nerves.
T5-T12
58
Describe the sympathetic preganglionic fibers that form the (1) greater thoracic splanchnic nerve (2) lesser thoracic splanchnic nerve & (3) least thoracic splanchnic nerve.
1. Greater thoracic splanchnic nerve is formed by T5-T9 2. Lesser thoracic splanchnic nerve is formed by T10-T11 3. Least thoracic splanchnic nerve is formed by T12
59
How and where do vagal fibers enter into the abdomen?
The right and left vagal trunks enter the abdomen with the esophagus at vertebral level T10.
60
Where are all of the cell bodies of preganglionic sympathetic neurons located? (in terms of sympathetic innervation)
T5-L2
61
Describe the location of the intermesenteric plexus.
In between the two mesenteric arteries; also in between the two mesenteric plexuses.
62
What fibers might you find in the intermesenteric plexus?
1. mostly sympathetic pre and post ganglionic fibers | 2. some mini tiny ganglia where symp/pre fibers synapse instead of synapsing in the IMA or SMA