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Flashcards in organs of digestion Deck (60):
1

esophagus course

enters abdomen at esphogeal diaphragmatic hiatus at TV10
abdominal course only 1" enters stomach at TV11

2

esophogeal mesenteries and ligaments

phrenicoesophogeal ligaments- esophagus to diaphragm, allow for independent movement, prevent herniation of esophagus into thorax
mesoesophagus- mesentery of abdominal esophagus

3

esphogeal contrictions

cervical- due to circopharynegeus m
thoracic- due to arch of aorta and left primary bronchus
diaphragmatic- prevents reflux

4

abdominal esophageal blood supply and lymphatics

left gastric a and v
left gastric nodes -> celiac nodes

5

hiatal hernias

herniation of esophagus and/or stomach through esophogeal hiatus
paraesophageal- fundus of stomach herniates through esophageal hiatus anterior to esophagus, may strangulate
sliding- caused by weakening of phrenicoesophageal ligaments allowing cardia and fundus of stomach to herniate into thorax

6

regions of stomach

cardia
fundus
body
pyloric

7

cardia

portion surrounding cardiac orifice
typically TV11

8

fundus

expanded superior portion of stomach
separated from esophagus by cardiac notch

9

body

btwn fundus and pyloric antrum
angular incisure is sharp angulation of lesser curvature where body in continuous w/pyloric region

10

pyloric region

antrum- funnel shaped outflow
pyloric canal- narrow inferior portion
pylorus- portion containing pyloric sphincter, normally locates to the right of midline at LV1/2

11

layers of stomach wall

serosa
muscular layer
mucosa

12

muscular layer of stomach

outer longitudinal layer
inner circular layer (forms pyloric sphincter)
innermost oblique layer

13

mucosa layer of stomach

arranged in folds called gastric folds (rugae)
most prominent along greater curvature and from gastric canal along lesser curvature

14

stomach mesenteries

lesser and greater omentum

15

lymph supply of stomach

gastric nodes along lesser curvature to celiac nodes
gastroepiploic nodes along greater curvature to celiac nodes

16

duodenum

first part of small intestiines 12"
c-shaped courses around head of pancreas

17

duodenum divisions

first (superior)
second (descending)
third (horizontal)
fourth (ascending)

18

superior duodenum

continuous w/pylorus, anterior to LV1
peritonealized assocaiates w/hepatoduoldena ligament
called duodenal bulb bc of thin wall

19

desending duodenum

descends along right side from LV1-3
retropertitoneal
major duodenal papilla (opening for hepatopancreatic ampulla)
minor duodenal papilla (opening for accessory pancreatic duct

20

horizontal duodenum

runs transversly from right to left at LV3
retroperitoneal

21

ascending duodenum

ascends to left of VC from LV3-2
retropertitoneal, except for very end
duodenojejunal flexure
suspensory ligament of treitx supports this flexture

22

anatomical relationships of duodenum- superior

anterior and superior- gallbladder and liver
posterior- common bile duct, gastroduodenal a,
portal v
inferior- head of pancreas
herniation or ulceration of this can erode the gastroduodenal a

23

anatomical relationships of duodenum- descending

anterior- liver, gallbladder, transverse colon, small intestines
posterior- right kidney, renal vessels, IVC
medial- pancreas, gastroduodenal a, bile and pancreatic ducts

24

anatomical relationships of duodenum- horizontal

anterior- superior mesenteric vessels, root of mesentery
posterior- right psoas major, IVC, aorta, right gonadal vessels
superior- head and uncinate process of pancreas

25

anatomical relationships of duodenum- ascending

anterior- root of mesentery, small intestines
posterior- aorta, left psoas major

26

internal feature so duodenum

villi- folds of mucosa which increase surface area for absorption
plica circularis- folds of mucosa and submucosa

27

stomach bed

diaphragm
spleen
left kidney
suprarenal gland
pancreas
transverse colon and transverse mesocolon

28

paraduodenal hernias

inconstant folds of peritoneum that surrond the third and fourth parts of the duodenum
sometimes small intestines can herniate into paraduodenal fossa created by these folds
surgical repair needs to be careful not to injure inferior mesenteric vessels

29

lymphatics of duodenum

anterior to pancreaticoduodenal nodes -> pyloric -> celiac nodes
posterior drainage to superior mesenteric nodes

30

jejunoileum

pertionealized
6-7m long
jejunum 2/5s of this mostly in LUQ
illeum 3/5s mostly RLQ and false pelvis

31

mesentery proper

root- where attached to posterior body wall
extends on left from LV2 to right sacroiliac joint
crosses duodenum, aorta, IVC, ureter, psoas major, right gonadal vv

32

ilium compared to jejunum

thicker wall due to more mm and wider diameter
more plica circulares
incresed vascularity and deeper red color
less mesenteric fat
few peyers patches

33

paralyticileus

obstruction of intestine
can be caused by loss of blood supply

34

lymphatic drainage of jeunoileum

juxta-intestinal nodes -> mesenteric nodes -> superior mesenteric nodes

35

large intestine

cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal

36

external cecum -> rectosigmoidal junction

larger diameter then small intestine
tenja coli- longitiudinal muscle is incomplete and present as 3 thick bands
haustra- sacculations of large intestine caused by tonic contractions of tenja coli
omental appendages (fat)

37

internal cecum -> rectosigmoidal junction

plica semilunares
mucosa devoid of villi

38

cecum and appendix

peritonealized
RLQ

39

internal cecum

ileal orifice surrounded by superior and inferior ileocolic lips
no sphincter around ileal orifice, however contraction of terminal ileum likely prevents reflux

40

appendix

blind ending diverticulum contianing lymphoid tissue
usually in a retrocecal position
mesoappendix

41

appendicitis

initially referred pain T10 dermatome
once spreads to parietal peritoneum pain localized to McBurney (1/3 from ASIS to umbilicus)

42

lymphatics of cecum and appendixx

ileocolic nodes-> superior mesenteric lymph nodes

43

colon

ascending, transverse, descending, sigmoid,
right colic flexure (hepatic)
let colic flexure (splenic)- where phrenicocolic lig attaches
R/L paracolic gutters

44

ascending colon

retroperitoneal
anterior- small intestine, greater omentum
posterior- posterior body wall, kidney
medial- small intestine
lateral- transversus abdominis

45

transverse colon

peritonealized
anterior- anterior body wall
posterior- transverse mesocolon
superior- liver, gallbladder, stomach, spleen
inferior- small intestines

46

desceding

anterior- small intestine
posterior- posterior body wall
medial- small intestine
lateral- transversus abdominis

47

large intestine lymph

paracolic -> R/middle colic nodes -> superior mesenteric nodes
paracolic -> L colic nodes -> inferior mesenteric nodes

48

rectum

rectosigmoidal jnx at SV3
terminates at anal canal
6-8"

49

external rectum features

sacral flexures- follows curvature of sacrum
teniae coli spread out as a continuous layer of longitudinal m
absence of fatty ormental appendages
anorectal flexure- posteroinferior angulation as rectum passes through pelvic diaphragm

50

internal rectum features

transverse rectal folds- 2 left, 1 right, folds of mucosa, submucosa, and m which support fecal mass
ampulla- dilated, termina portion of rectum proper, importatn for maintaining fecal continence

51

rectum lymph

pararectal nodes drain along superior rectal a to inferior mesenteric nodes
pararectal nodes drain along middle rectal a to internal rectal nodes
inferior half to sacral and internal iliac nodes

52

internal anal sphincter

surrounds 2/3s of anal canal
sympathetic (L1,2) contracts
parasympathetic (S2-4) relaxes

53

external anal sphincter

surronds 2/3s of anal canal
voluntary, innervated by inferior rectal n

54

anal columns

vertical folds of mucosa containing superior rectal vessels

55

anal sinuses

small recesses at base of anal columns

56

anal valves

folds of epithelium connecting caudal ends of rectal column

57

pectinate line

formed by anal valves
represents a change in:
-venous drainage; superior-> drains to superior and middle rectal vv inferior -> drains to inferior rectal v
-lymphatic; superior -> internal iliac nodes, inferior-> superficial inguinal nodes
-nerve supply; superior- autonomic, inferior -> somatic
- epithelial lining; superior-> typical GI mucous lining, inferior -> stratisfies squamous

58

lymph anus

superior to pectinate line- internal iliac nodes
inferior to pectinate line- superficial inguinal nodes

59

internal hemorroids

usually painless
bright red bleeding
hypertension, pregnancy, constinpation

60

external hemorroids

usually painful
pregnancy, constipation, increased abdominal pressure