Oesophagus stomach and duodenum Flashcards
(78 cards)
1
Q
What are the 4 non-pathological constrictions of the oesophagus?
A
- Cricopharyngeal (upper oesophageal) sphincter
- Arch of aorta
- Left main bronchus
- Diaphragm
2
Q
What can constrictions cause?
A
- Blockade
- Hinder passage of instruments
- Slow down the passage of caustic substances -> more damage
3
Q
What level is the upper oesophageal sphincter?
A
C6
4
Q
What level is the arch of the aorta?
A
T4
5
Q
What level is the diaphragm?
A
T10
6
Q
What chamber of the heart is the oesophagus related to anteriorly?
A
Left atrium
7
Q
What berve(s) are the middle and lower thirds of the oesophagus innervated by?
A
- Oesophageal plexus (which is):
Vagus
T1-4
Splanchnic
8
Q
Where is the abdominal oesophagus located?
A
Oesophageal hiatus to the cardiac orifice of the stomach
9
Q
What does the oesophagus pass through specifically at T10?
A
Right crus of the diaphragm
10
Q
What is the abdominal oesophagus tethered to the margins of the oesophageal hiatus by?
A
Phrenooesophageal ligament
11
Q
What is the arterial supply of the abdominal oesophagus?
A
Branches of the left gastric artery, a branch of the coeliac trunk
12
Q
What is the abdominal oesophagus drained by?
A
- Short gastric -> left gastric -> portal vein
- Oesophageal veins -> azygos system
13
Q
What is the nerve supply of the abdominal oesophagus?
A
- Parasympathetics from vagus
- Sympathetics from greater splanchnic
14
Q
What is the lymph drainage of the abdominal oesophagus?
A
- Left gastric lymph nodes
- > Celiac lymph nodes
15
Q
What is a sphincter?
A
- Circular muscle fibres around a hollow organ
- Serves to guard or close an opening
16
Q
What is the “High Pressure Zone”
A
- Pressure gradient between abdomen and thorax
- Around lower 2 - 4 cm of the oesophagus
17
Q
What are the 2 major and multiple minor anti-reflux mechanisms?
A
- Circular smooth muscle fibers in the lower oesophagus
- Right crus of diaphragm
18
Q
What are the minor anti-reflux factors?
A
- Clasp fibres
- Oblique entry of the oesophagus into the stomach
19
Q
What are clasp fibres?
A
- Circular muscle fibres from lesser to gretaer curvature
- Lie just below gastro-oesophageal junction
20
Q
What is achalasia?
A
- When ganglion cells in the myenteric plexus of the distal oesophagus and gastro-oesophageal junction are reduced or absent
- Lower oesophageal sphincter fails to open up during swallowing
21
Q
What is Barrett’s oesophagus?
A
Pathological replacement of oesophageal squamus epithelium by gastric columnar epithelium
22
Q
What does the gastro-oesophageal junction look like?
A
- Circumferential ‘zigzag’ line
- Between pale pink oesophageal squamous epithelium above and the red columnar epithelium below
23
Q
What is the stomach?
A
- Dilated muscular sac
24
Q
Where is the stomach located in terms of abdominal regions?
A
- Epigastric
- Left hypogastric
- Partially umbillical regions
25
What is Labbe triangle?
- The location where the stomach is normally in contact with the abdominal wall
- Left costal arch
- Lower border of liver
- Horizontal line connecting the tips of right and left 9th costal cartilages
- Varibale
26
What are the functions of the stomach?
- Storage
- Digestion
- Secretion
27
What are the 4 parts of the stomach?
- Cardia
- Fundus
- Body
- Pyloric part
antrum + canal
28
What are the 3 layers of muscle in the stomach?
- Longitudinal
- Circular
- Oblique
29
What forms the pyloric ssphincter?
- Circular fibres in the pyloric sphincter
| - Controls outflow of gastric contents into duodenum
30
What is the arterial supply of the foregut?
Coeliac trunk
31
What is the arterial supply of the midgut?
Superior mesenteric artery
32
What is the arterial supply of the hindgut?
Inferior mesenteric artery
33
What are the 3 branches of the celiac trunk?
- Common hapaticc artery
- Left gastric artery
- Splenic artery
34
What is the arterial supply of the stomach?
- All derived from coeliac trunk
- Left gastric (direct branch)
- Right gastric (branch of common hepatic)
35
What is the arterial supply of the stomach?
- All derived from coeliac trunk
- Left gastric (direct branch)
- Right gastric (branch of common hepatic)
- Left gastroepiploic (branch of splenic)
- Right gastroepiploic (branch of the gastroduodenal branch of the common hepatic artery)
- Short gastric arteries (branches of splenic)
36
Where does the right gastric artery run/supply?
- Branch of common hepatic
- Runs along lesser curvature
- Distal lesser curvature and adjacent body of the stomach
37
Where does the right gastric artery run/supply?
- Branch of common hepatic
- Runs along lesser curvature
- Distal lesser curvature and adjacent body of the stomach
38
Where do the short gastric arteries run?
- Branches of the splenic arteries
- Runs in the gastro-splenic (gastro-lienal) ligament
- The fundus of the stomach
39
What do the veins of the stomach follow?
They run parallel to the arteries of the stomach
40
What do the left and right gastric veins drain into?
The hepatic portal vein
41
What do the short gastric and left gastroepiploic veins drain into?
The splenic vein -> Hepatic portal vein
42
What does the right gastroepiploic vein drain into?
The superior mesenteric vein -> Hepatic portal vein
43
What is lymh from the stomach initially passed to?
Nodes that lie along the arteries
44
What is lymph eventually drained by in the stomach?
The coeliac nodes
45
What is the can be the consequence of retrograde lymph flow from coeliac nodes?
- Spread of cancer from coelic nodes to hepatic lymph nodes (stomach to liver)
- Enlarged hepatic lymph nodes might compress on bile duct and patient may present with jaundice
46
What is the sympathetic nerve supply to the stomach?
- Greater splanchnic nerve (T5-9)
- Coeliac plexus
- Pain and vasomotor
47
What is the parasympathetic nerve supply to the stomach?
- Vagal trunk
- Increase secretion
- Increase motility, relax sphincters
- Afferents for emesis
48
What do the parasympathetics from the vagal trunks and sympathetics from the splanchnic nerve (T5-9) form?
A plexus
49
What is pain carried by?
The sympathetics, referred to epigastric region and lower chest
50
What is general sensation (nausea, vomitting, general discumfort) carried by?
Parasympathetics
51
What is a hiatus hernia?
Herniation of the stomach through the diaphragm into the mediastinum
52
What groups are ore suseptible to a hiatus hernia?
Elderly and obese
53
Where is pain from the lower oesophagus referred to?
Retrosternal area
54
What are the 2 types of hiatus hernia?
- Sliding hernia (>90%) all in thoracic cavity
| - Para-oesophageal (rolling) hernia most in thoraic cavity
55
What can para-oesophageal hernias cause?
- Obstruction and/or ischaemia of the herniated stomach
| - May be asymptomatic or be associated with symptoms of gastro-oesophageal reflux
56
How much milk can a newborn's stomach contain?
30 - 60 ml
57
What is the benefit of cutting the vagus supply to the stomach?
- Reduces gastric acidity and prevents ulcers
58
What are the three types of vagotomy operations?
- Truncal
- Selective gastric
- Selective proximal
59
What are the side-effects of a vagotomy?
- Shphincteric dysfunction
| - Fullness
60
What is a selective or highly selective vagotomy?
- Vagus supply is reduced but branches to pyloric sphincter are preserved
- Reduces acid secretion while maintaining motility
61
What parts of the duodenum are considered retroperitoneal?
2 - 4
62
What is the function of the duodenum?
- Digestion (especially of fats) and absorption
63
What is needed in order to absorb and digest fats?
Bile
64
What are the 4 parts of the duodenum?
- Superior (ampulla or duodenal cap)
- Descending
- Horizontal
- Ascending
65
What level is the 1st part of the duodenum?
- Transpyloric plane: Lower L1
66
Where does the duodenum descend from?
L2 to L3
67
Where is the duodenum horizontal?
L3
68
Where does the duodenum ascend to?
L2
69
What is the duodenojejunal flexure (ligament of Treitz)?
Suspends duodenum to diaphragm after it is jejunum
70
What is the minor duodenal papilla?
Opening of the accessory pancreatic duct
71
What is the major duodenal papilla?
- Common opening of the common bile and pancreatic ducts
| - Boundary between foregut and midgut
72
What artery(s) is the duodenum up to the duodenal papilla supplied by?
- Foregut
- Branches of common hepatic
Gatroduodenal artery: supraduodenal artery, superior pancreaticoduodenal artery (ant + post)
73
What is the rest of the duodenum (onwards from ampulla of Vater) supplied by?
- Midgut
- Branches of superior mesenteric artery
Inferior pancreaticoduodenal artery (ant + post)
74
Branches of what 2 major arteries achieve collalteral circulation around the duodenum?
Coeliac trunk and superior mesenteric artery
75
What artery is at risk with posterior with posterior ulcers of the 1st part of the duodenum?
Gastroduodenal artery
76
What is the nerve supply of the duodenum?
- Sympathetic fibres via the greater splanchnic nerves (T5-9)
- Parasympathetics from vagus via the coeliac and superior mesenteric plexuses
77
What is bariatric surgery?
- Surgery to lose weight
78
What are the 3 most common types of bariatric surgery?
- Gastric band
- Gastric bypass
- Sleeve gastrectomy
