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MD3002 GI > Oesophagus, stomach and duodenum > Flashcards

Oesophagus, stomach and duodenum Flashcards

1
Q

what are the 3 gut divisions and what does each part include?

A

1) Foregut:
- liver
- gallbladder
- pancreas
(half way along the oesophagus to the 2nd part of the duodenum)

2) midgut: 1/2 way along the 2nd part of the duodenum to the proximal 2/3 transverse colon.

3) hindgut:
- distal 1/3 transverse colon to the proximal half of the anal canal.

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2
Q

describe the blood supply to the gut divisions?

A

each region is supplied by a branch of the abdominal aorta.

foregut= coeliac trunk

midgut= superior mesenteric

hindgut = inferior mesenteric

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3
Q

what are the 3 main branches of the coeliac trunk?

A

1- splenic
2- left gastric
3- common hepatic

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4
Q

what are the 4 physiological constrictins of the oesophagus?

A
  • cricopharyngeal sphincter C6
  • arch of the aorta T4
  • left main bronchus
  • oesophageal hiatus T10
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5
Q

what is the problem with the physiologcal constrictions of the oesophagus?

A
  • they may impede instrumets
  • predispose to blockage
  • site of damage if caustic substances gets trapped
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6
Q

at what level is oesophagus continues with the pharynx?
what route does it take from here?

A
  • continous with the pharynx at C6
  • from here it is in the midline between the trachae and the vertebral column, descending towards the left
  • enters the abdomne through the diapghram at T10
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7
Q

how is the oesophagus connected to the diapghram?

A

by the phrenico-oesophageal ligament
- this has independant movement during function

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8
Q

what is the abdominal eosophagus?

A

this is the 1.25 cm of oesophageal hiatus to the cardial orifice of stomach

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9
Q

describe the arterial suply of the abdominal oesophagus?

A

supplied by the oesophageal branch of the left gastric artery (from coeliac trunk)

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10
Q

describe the venous supply of the abdominal oesophagus?

A

it has 2 venous drainage supplies:

it is supplied by the oesophageal branch of the left gastric vein
this will drain into either..,
1- hepatic portal system (left gastric vein)
2- azygos system via the oesphageal veins.

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11
Q

what is the porto-systemic anastomoses prone to?

A

it is prone to oesopheal varices in cases of portal hypertension

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12
Q

where does the oesophageal plexus supply?

A

The esophageal plexus supplies autonomic innervation to the mid and lower esophagus and transmits parasympathetic fibers to the abdomen.

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13
Q

describe the sympathetic and parasympathetic supply of the oesophageal plexus?

A

parasympathetics= from vagus nerve (they become vagal trunks)

sympathetics = from the greater splanchnic nerves T5-T9

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14
Q

lymphatics of the oesophagus?

A

lymphatics = left gastric nodes to coeliac nodes

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15
Q

where is the lower oesophageal pain reffered too?

A

retrosternal area

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16
Q

what are the multiple components of the oesphageal sphincter?

what is their overall function?

A
  • circular smooth muscle of the lower oesophagus
  • right crus of diapghram
  • ‘clasp’ fibres at junction with stomach
  • oblique entry into stomach

FUNCTION:
to prevent refluc of stomach contents

all the components act colectivly to work as a sphincter

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17
Q

what is achalasia?

problem with the lower oesophageal sphincter

A
  • this makes it difficult to swallow
  • sphincter resists opening, linked to fewer ganglia in myenteric plexus at distal oesophagus
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18
Q

what is the Z line?

A
  • this is the junction between mucosa of the stomach and oesophagus
  • irregular and jagged
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19
Q

what is the differance in epithelium between oesophagus and stomach?

A

oesophagus = non-keratinised stratified squamos epithelium

stomach = simple columnar epithelium with gastric pits (gastric secretions)

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20
Q

what is Barret’s oesophagus?

A
  • a premalignant metaplastic change in the lower oesophagus
  • the oesophagus epithelium will change to gastric epithelium
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21
Q

what is Mallory Weiss tear?

A

this is a longitudinal tear within the gastroeosphageal mucosal junction (a lot of blood)

due to forceful, repeated retching/vomitting/coughing

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22
Q

describe the position of the stomach in the body?

A
  • muscular sac that is capable of distending up to 3L
  • position varies depedning on body habitus
23
Q

what are the main functions of the stomach?

A
  • food reservoir
  • mechanical digestion, mixing with gastric secretions
  • chemical digestion
  • controlled release of contents into duodenum
  • has specialised cells that contribute to secretions
  • these cells tuen over rapidly (every 3-5 days)
24
Q

what are the different regions of the stomach?

A
25
Q

at what level is the transpyloric plane?
what will you find here?

A

L1
- pyloric sphincter
- pyloric orifice
- pyloric canal

26
Q

what are the 3 layers of smooth muscle in the stomach?

A
  • outer longitudinal
  • middle circular (pyloric sphincter is a thickening of this layer)
  • inner oblique
27
Q

anteriorly, what is the stomach related to?

A
  • anterior abdominal wall (Labbe’s triangle)
  • left pleura, lung and diaghpram
  • left lobe of the liver
28
Q

posteriorly, what is the stomach related to?

A
  • diapghram
  • omental bursa/lesser sac
  • spleen
  • left kidney/suprarenal gland
  • splenic artery and vein
  • pancrease
  • transverse mesocolon
29
Q

describe the arterial supply of the stomach?
and the anastomes?

A
  • all coeliac trunk branches supply the stomach either directly or via other branches.
  • there is an anastomes on both curvatures
  • on the lesser curvature = the left and right gastric arteries will anastomes
  • on the greater curvature = the left and right gastro-omental arteries will anastomes
  • there is also the short gastric artery to the fundus region which is a branch of the splenic artery
30
Q

describe the venous supply of the stomach?

A
  • all drains into the hepatic portal system
  • right gastric directly into the portal vein
  • right gastro-omental will join the superior mesenteric vein
  • left gastric, short gastric and left gastro omental will drain into the splenic vein
31
Q

describe the lympatic supply of the stomach?

A

there are multuple lymoh vessels around it that will all drain into the coeliac nodes, for example:
- pancreaticosplenic
- gastro omental
- gastric
- mesenteric
- pyloric nodes

32
Q

what is different about the lymphatic drainage of the stomach?

A

it travels retrograde (it opposite direction) this is a possible source of tumour spread

33
Q

describe the innervation of the stomach?

sympathetic and para sympathetic

A

sympathetic = from the greater splanchnic nerve T5-T9 to the celiac plexus then to the peri-arterial postsynaptic fibres

parasympathetic = from the anterior and posterior vagal trunks, with respective gastric branches

  • secretomotor = promotes digestion
  • afferent for emesis
34
Q
A
34
Q

where will reffered pain go to for the stomach

A

epigastric region

vasomotor

35
Q

what is a hiatus hernia?

A

when the stomach protrudes through the diapghram into the mediastinum
- happens in the elderly, obese and pregnant.

36
Q

what are the 2 types of hiatus hernia?

A

sliding = oesophageal gastric junction is above the diapghram.
- managed conservativly (weight loss, mamange GORD symptoms)

rolling = paraoesophageal, not above the diapghram.
- may cause ischamia or obstruction
- surgery may be required.

37
Q

describe the small intestine and its 3 parts?

A
  • longest section of the digestive system
  • from the pylorus (stomach) to the ileoceacal valve (large intestine)
  • highly folded
  • main site of digestion and nutrient absorption
    has three sections:
  • duodenum
  • jejunum
  • ileum
38
Q

describe the duodenum?
what are its 4 parts?

A

C shaped
- goes from the pylorus to the duodenojejunal flexure
- retroperitoneal (except initial ampulla)
4 parts:
- superior
- descending
- horizontal
- ascending

39
Q

what does the descending part of the duodenum receive?

A

bile and pancreatic secretions from the hepatopancreatic ampulla (this is the demarkation for the hind and forgut)

for digestion and absorption

40
Q

what are the minor duodenal papilla?

A

The minor duodenal papilla is the opening of the accessory pancreatic duct into the descending second section of the duodenum

41
Q

what vertebral levels does the duodenum cross?

A

L1
L2
L3

42
Q

what does the suspensory ligamnet of the duodenum do?

A

it is a band of smooth muscle that holds the duodenum away from the diapghram

43
Q

describe the arterial supply of the duodenum?

A
  • celiac trunk and the superior mesenteric artery anastomose to supply the duodenum
  • the anastomoses is called the superior and inferior pancreaticoduodenal arteries.
44
Q

branches of the celiac trunk to supply the duodenum?

A

duodenum … common hepatic… gastroduodenal …. supraduondenal and anterior and posterior superior pancreaticoduondenal arteries.

45
Q

branches of the superior mesenteric to supply the duodenum

A

superior mesenteric… anterior and posterior inferior pancreaticoduodenal arteries

46
Q

describe the lymphatic drainage of the duodenum?

anterior and posterior drainage

A
  • follows arteries
  • anterior goes too… pancreaticoduodenal lymph nodes and pyloric
  • posterior goes too… superior mesenteric lymph nodes

all will go to celiac lymph nodes

47
Q

describe the innervation of the duodenum?

what does this form?

A

sympathetics:
- greater splanchnic (T5-T9)
- lesser splanchnic T10,T11

Parasympathetics:
- vagal trunk

this forms the coeliac and superior mesenteric plexus.

48
Q

what are the different types of bariatric surgery?

surgery on the stomach

A

gastric bypass:
- the cardiac notch of the stomach is connected to the jejunum

adjustable gastric banding:
- adjustable band is put around the top part of the stomach (weight loss surgery)

gastric sleeve:
- removes a large portion of the stomach, removing Ghrelin cells, these are cells reposnible for hunger.

49
Q

what are the pros and cons of bariatric surgery?

A
50
Q

what is a whipple procedure?

A

surgery performed to remove cancerous tumours from the head of the pancreas

  • gallbladder is removed
51
Q

what vessel will supply the fundus region of the stomach?

A

short gastric

52
Q

the major duodenal papilla is the site of important secretions into the duodenum, what organs contribute to these secretions?

A

liver
gallbladder
pancrease

53
Q

The stomach has many secretions, what is the function of each:
-HCL
-mucus
- intrinsic factor
- lipase
- pepsinogen
- wide range of hormones

A

MD3002 GI (10 decks)

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