The Intestines and The Anus

Question 1

The highest point of the abdomen is the highest point of the diaphragm which is at what vertebral level

Answer 1

T8

Question 2

What is the most inferior part of the abdomen

Answer 2

Pelvic inlet

Question 3

Pylorus, duodenum , jejunum , ileum , caecum , ascending Color , traverse colon , descending colon , sigmoid colon , rectum …

Answer 3

Anal canal

Question 4

What are the two turning points of the large Intestine

Answer 4

Hepatic flexure and then splenic flexure

Question 5

3 branches of the abdominal aorta supply the intestines
This is the celiac trunk
Sup. Mesenteric artery
Inf. mesenteric artery

What Levels do these break off the abdominal aorta and what do they supply

Answer 5

T12 forgut
L1 midgut
L3 hindgut

Question 6

The superior mesenteric artery supplies the ascending colon and majority of transverse and small intestine so distal transverse colon is where the midgut ends
Which artery from the superior mesenteric artery anastomoses with branches of the inferior mesenteric artery so their is collateral circulation so if clot In IMA still works

Answer 6

Middle colic artery

Question 7

Venous drainage runs back up to liver- liver uses that blood and then goes back into circulation - what vein takes this

Answer 7

Hepatic portal vein

Question 8

Superior mesenteric vein drains midgut and join with splenic artery to form hepatic portal vein
The inferior mesenteric vein joins splenic vein at different point to then become hepatic portal vein
Forms what kind of letter

Answer 8

H

Question 9

The small intestine is within the midline of the abdomen and is framed by the large intestine it has e part duodenum starting at pylorus at L1 and runs into real shape from left to right jejunum then ileum which occupies lower right quadrant with the caecum.
General direction of left upper to right lower
At what level is the dudoenojejunal junction

Answer 9

L3

The small interior ends in RIF ileocecal valve

L4 - bowel is just associated with itsel
L3 inferior poles of kidneys

Question 10

In larger individuals with large central abdominal fat they can have a higher traverse colon. In thin individuals there is no far so how low could the transverse colon be

Answer 10

L5

Question 11

Is the bowel intraperitoneal ?

Answer 11

Yes surrounded by blood vessels behind and mesenteric

Question 12

What layers is the myenteric plexus between

Answer 12

Muscularity externa - circular and longitudinal

Question 13

What are valvulae connivents

Answer 13

Circular folds increase SA

Small intestine get villi

Question 14

Duodenum is made up of 4 parts, superior , descending , horizontal and ascending which part Is intraperitoneal

Answer 14

Superior

Question 15

Ampulla of vater

Answer 15

Bile duct enter the duodenum - bile is digestive juice and that has to enter the duodenum to help with digestion and this is said to correspond with embryo logical foregut

Question 16

SMA will emerge just superior to where the left renal vein travels across the anterior face of the abdominal aorta - the runs to anterior part of duodenum

Left renal vein is visible just under what

Answer 16

Pancreatic tail

Aorta enters abdomen through diaphragm T12 than the IVC T8

Question 17

Coeliac trunk supplies the foregut and has branches such as common hepatic artery and gastroduodenal artery which runs behind the superior part of the duodenum is this area prone to ulcers

Answer 17

Yes

Question 18

Two differences between the jejunum and ileum

Answer 18

Jejunum has much thicker muscular wall. More circular in its lumen compared to the ileum

Ileal loops tend to lie in the inferior part of the abdomen and pelvis
Jejunum has less villi

Question 19

Jejunum has 1-3 so fewer arterial arcades ( circles) and fewer and longer vasa recta

Answer 19

True ileum has 2-6 arcades and has numerous shorter and thinner vasa recta

Question 20

What are peyers patches ?

Answer 20

Aggregates of lymphoid tissue found in the luminal wall and are often palpable - bowel intussusception in children - bowel folds in ahead of it
Ileum has loads found through the length

Question 21

What is a plexus

Answer 21

Web of nerves - come from the spinal cord branch off and then come back together again - some are autonomic and some are soamticsly innervated

Question 22

Ganglion

Answer 22

2 neurones synapse together

Question 23

Greater splanchic nerve

Answer 23

t5-9

Question 24

Lesser splanchic nerve

Answer 24

T10-11

Question 25

Least splanchic nerve

Answer 25

T12 Sympathetic runs through splanchic nerves and parasympathetic through vagus nerves

Question 26

Where is most water is absorbed from undigested chyme

Answer 26

Large intestine

Question 27

4 distinct features that separate large intestine from small intestine

Answer 27

Larger diameter Teniae coli - emerge from appendix and form 3 strands - merge again at rectum Haustra Omental appendices

Question 28

3 tenia coli

Answer 28

Mesocolic , omental and free tenia Diverge. And then reconnect

Question 29

Haustra

Answer 29

Tenia coli smooth muscle and just have a tone of contracted they pull bits of the large vowel together to form pouches called haustra producing wrinkles Like bubbies and bulges

Question 30

What tool can you use to tell the difference between haustra and valvulae conniventes Haustra don’t cross the whole width Valvulae conniventes cross the whole width

Answer 30

X-ray

Question 31

Omental appendage

Answer 31

Little fat tags on the large intestine

Question 32

What parts of the large intestine are retoperiotneal

Answer 32

Ascending and descending

Question 33

Paracolic gutters

Answer 33

Potential space between the lateral surface of ascending surfaces of colon and peritoneal ,membrane at the side of them- path of least resistance so infection runs

Question 34

Rectum is 15cm - anal canal 4-5cm Anal viaves secrete mucus and get faeces out of anal canal where are they found

Answer 34

Anal columns

Question 35

What is the denate line

Answer 35

Embrylogical divide between endoderm and ectoderm Transfer of columnar epithelium to stratified squamous epithelium of skin

Question 36

What muscle supports rectum

Answer 36

Lavatory ani

Question 37

Ischiorectal fossa Canal

Answer 37

Abscess Ischial tuberous it and medially Pudendal canal sup to inf artery vein then nerve abscesses injur nerve Gangrene

Question 38

Appendices pain

Answer 38

Travelling pain starts in midline as the visceral peritoneum is irritated . This layer only has a sensory supply from visceral to autonomic fibres so pain generalised to a dermatome. As inflammation worsens the parietal peritoneum irritated so pain localised to RIF where the appendices usually sits. Umbilicus to right iliac fossa

Question 39

Diverticulitis is classically described as LIF maybe opposite in Asian, infection if one of the outpouchings - localised well True or false

Answer 39

True

Question 40

Mcburnleys point is found where What is this the common location for

Answer 40

Between the umbilical and antihero superior iliac spine - 1\3 from the ASIS Appendix’s

Question 41

In small vs large vowel obstruction Small bowel is pain central and valvulae conniventes cross all lumen and dilated bowel about 3cm What happens in large bowel obstruction

Answer 41

Pain in normally in lower abdomen Haustra do not cross the lumen Dilated bowel to over 6cm

Question 42

Where does the small intestine finish Enterocytes msot numerous cell - nutrient electrolyte and fluid absorption

Answer 42

Ileocecal valve Terminal ileum absorbs bile salts and B12 special All small bowls in intraperitoneal except distal 3 parts of the dudodneum

Question 43

Level of transverse colon

Answer 43

L3 - umbilical level Left colic flexure more superior than right as liver not pushing down Sigmoid colon is continuous with the rectum

Question 44

Sigmoid colon is continuous with the rectum at what vertebral level

Answer 44

S3

Question 45

In the intestines what parts are retoperitoneal

Answer 45

Ascending , descending colon and distal 3 parts of the duodenum Rectum and anus are sub peritoneal

Question 46

The parasympathetic fibres in the juejunum and ileum derive from what

Answer 46

Posterior cabal trunk

Question 47

Where the internal sphincter ( autonomic ) and external sphincter ( somatic ) meet is called

Answer 47

Anorectal ring