Organs of GI Tract Part 2

Question 1

What is the cecum?

Answer 1

blind pouch (intraperitoneal) continuous w/ ileum & ascending colon

also where appendix attaches (@ posterior-medial cecum)

Question 2

What is the ileal papilla?

Answer 2

cone-like projection of ileum into the cecum

Question 3

Describe the external features of the large intestine

Answer 3

3 tenia coli

longitudinal bands of smooth m, haustra & appendices epiploicae

Question 4

What is the role of the appendix?

Answer 4

contains several lymphoid nodules (part of immune system)

Question 5

What are signs of acute appendicitis?

Answer 5

ill looking pt, low grade fever

coughing may cause increased pain

tenderness @ McBurney’s point (involuntary guarding)

pain felt in RLQ during palpation of LLQ (Rovsing’s sign)

Question 6

Where is McBurney’s point?

Answer 6

2/3 along line from umbilicus to ASIS

Question 7

What is an ileal diverticulum?

Answer 7

inflammation of intestines near ileocecal junction

mimicks pain produced by acute appendicitis

Question 8

What is the role of the ileocecal valve?

Answer 8

regulates passage of ileal contents into cecum

Question 9

Where is the ascending colon and to what does it connect?

Answer 9

retroperitoneal organ adj to R paracolic gutter

connects to cecum & to transverse colon @ R colic (hepatic) flexure

Question 10

Where is the transverse colon and to what does it connect?

Answer 10

intraperitoneal (suspended by transverse mesocolon)

continuous w/ descending colon @ L colic (splenic) flexure

Question 11

Where is the descending colon and to what does it connect?

Answer 11

retroperitoneal & medial to L paracolic gutter

continuous w/ sigmoid colon

Question 12

What does the sigmoid colon connect to?

Answer 12

suspended by sigmoid mesocolon & continuous w/ rectum @ level of S3

Question 13

What occurs in a volvulus of the sigmoid colon?

Answer 13

rotation & twisting of mobile loop of sigmoid colon & sigmoid mesocolon

leads to obstruction of lumen of descending colon & part of sigmoid colon next to twist

blocks passage of fecal matter & can lead to ischemia (ACUTE SURGICAL EMERGENCY)

Question 14

Where is the rectum located?

Answer 14

retroperitoneal & subperitoneal

located in pelvic cavity & ant to sacrum

Question 15

What does the rectum contain?

Answer 15

3 transverse rectal folds that overlie thickened parts of circular muscle layers

Question 16

What portion of the rectum is covered by peritoneum?

Answer 16

only the upper surface of the rectum

Question 17

What is the terminal part of the intestinal tract?

Answer 17

the anal canal

Question 18

Where is the pectinate line located?

Answer 18

@ inferior ends of anal valves

Question 19

What is the significance of the pectinate live?

Answer 19

above line is visceral sensory Ns & transitional epithelium

below is somatic sensory Ns & squamous epithelium

Question 20

Internal anal sphincter

Answer 20

smooth muscle & controlled by parasymp Ns

sensory fibers signal urge to defecate

Question 21

External anal sphincter

Answer 21

skeletal muscle, under conscious control

Question 22

Where is the spleen located?

Answer 22

in L hypochondriac region parallel to L ribs 9-11 (intra-peritoneal organ)

located along mid-axillary line (btwn stomach & diaphragm)

Question 23

What ligaments attach to the spleen?

Answer 23

gastrosplenic L

splenorenal L

Question 24

Describe the anatomical relationships of the spleen

Answer 24

anterior=stomach & tail of pancreas
posterior=diaphragm
inferior=left colic flexure
medial=left kidney & phrenicocolic ligament

Question 25

When is the spleen susceptible to rupture?

Answer 25

outer covering of spleen is weak & can cause bleed if torn becomes enlarged w/ infection like mono

Question 26

What is important when performing a splenic needle biopsy?

Answer 26

need to consider costodiaphragmatic recess of pleural cavity potential space that if entered could cause inflammation of pleura

Question 27

Where is the pancreas located?

Answer 27

retroperitoneal organ located @ level of L1-L2

Question 28

What does the head of the pancreas contact?

Answer 28

head of pancreas lies in curvature of duodenum

Question 29

What is significant about the neck of the pancreas?

Answer 29

overlies superior mesenteric artery

Question 30

What is the importance of the tail of the pancreas?

Answer 30

located w/ in splenorenal ligament adj to hilum of spleen

Question 31

What is the main pancreatic duct?

Answer 31

begins in tail of pancreas & joins common bile duct

Question 32

What prevents bile from entering pancreas?

Answer 32

sphincter of main pancreatic duct

Question 33

What is the sphincter of ODI?

Answer 33

hepatopancreatic sphincter (where bile & pancreatic ducts merge)

Question 34

Describe the anatomic relationships of the pancreas

Answer 34

``` anterior=lesser sac & stomach posterior=aorta, IVC, splenic v, common bile duct, R crus of diaphragm, L kidney, superior mesenteric A & V right=duodenum L=spleen inferior=duodenum ```

Question 35

Where is the liver located?

Answer 35

RUQ w/ left lobe in LUQ

Question 36

Where does the IVC contact the liver?

Answer 36

at the diaphragmatic surface (where not covered by peritoneum)

Question 37

What is the porta hepatis?

Answer 37

transverse fissure on visceral surface of the liver transmits the proper hepatic artery, the portal vein & the common bile duct

Question 38

What is found in the left sagittal fissure of the liver?

Answer 38

ligamentum teres (obliterated umbilical v)

Question 39

What is found in the right sagittal fissure of the liver?

Answer 39

contains gall bladder & IVC

Question 40

What separates the quadrate and caudate lobes of the liver?

Answer 40

porta hepatis

Question 41

How are the right and left lobes of the liver separated?

Answer 41

by the falciform ligament

Question 42

Which segments make up the L lobe of the liver?

Answer 42

I, II, III, IV

Question 43

Which segments make up the R lobes of the liver?

Answer 43

V, VI, VII, VIII

Question 44

What is the significance of lobes of liver?

Answer 44

R & L lobes are physiologically independent can surgically remove segments/lobes & retain liver function (can remove w/o bleeding b/c branches of hepatic portal vessels & ducts do NOT communicate btwn L & R)

Question 45

Liver biopsy

Answer 45

needle inserted thru R 10th intercostal space & mid-axillary line need pt to fully exhale to avoid entering costodiaphragmatic recess & damaging lungs

Question 46

Coronary ligaments

Answer 46

reflection of visceral peritoneum from liver to diaphragm

Question 47

What are the 2 parts of the lesser omentum?

Answer 47

hepatogastric L | hepatoduodenal L

Question 48

What does the hepatoduodenal L contain?

Answer 48

proper hepatic A, heptal portal v, common bile duct, lymphatic vessels & hepatic Ns

Question 49

What defines alcoholic cirrhosis?

Answer 49

hepatomegaly & hobnail appearance of liver surface due to fatty changes & fibrosis

Question 50

Cholelithiasis

Answer 50

gall stones in gall bladder (cholesterol crystals) can be loged in cystic ducts, hepatic duct, or hepatopancreatic ampulla

Question 51

How can gall stones cause pancreatitis?

Answer 51

block heptaopancreatic ampulla which blocks common bile & pancreatic duct bile will back up into pancreas

Question 52

What are the common risk factors for gall stones & gall bladder disease?

Answer 52

female forty fertile

Question 53

What is obstructive jaundice?

Answer 53

stones inside common bile duct & biliary tree

Question 54

Describe pathway of biliary system

Answer 54

``` bile canaliculi from liver cells interlobular bile ducts R & L hepatic ducts (to drain lobes of liver) common hepatic duct + cystic duct common bile duct ```

Question 55

Where is the gallbladder located?

Answer 55

lies w/ in hepatic fossa contacts anterior ab wall @ 9th costal cartilage