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WEEK 1:
Introduction to GI tract:
| Question | Answer |
|---|---|
| upper GIT route | mouth -> oesophagus -> stomach -> duodenum (small intestine) |
| lower GIT route | small intestine -> large intestine (colon) -> anus |
| upper GI (bleed) | above duodenojejunal junction |
| lower GI (bleed) | below duodenojejunal junction |
| clinical definition of GIT | from point of view of GI bleeding |
| diagnostic definition of GIT | from point of view of endoscopic imaging + duodenojejunal junction |
| diagnostic upper GIT | oesophagus, stomach, duodenum |
| diagnostic lower GIT | jejunum, ileum -> colon, rectus, anus |
| conventional upper GIT | mouth to ileum |
| conventional lower GIT | caecum to anus |
| regions of stomach include (2) | external and internal features |
| external stomach regions | cardia, fundus, body, pyloric antrum, pyloric canal, and pylorus |
| fundus of stomach | bulges upwards and is sometimes full of gas |
| body of stomach | cardiac orifice to angular incisure |
| shape of pyloric antrum of stomach | funnel shape |
| pylorus of stomach | sphincter regions where TPP (trans pyloric plane) runs through |
| surfaces of stomach (2) | anterior and posterior |
| openings of stomach (2) | cardiac orifice and pyloric orifice |
| curvatures of stomach (2) | lesser and greater curvature |
| internal features of stomach | rugae |
| rugae can be seen using which diagnostic test | radiograph |
| rugae | longitudinal folds which are stretched when stomach becomes full and lining becomes flat |
| relations in stomach (anything lying around eg above or behind) (2) | peritoneal and visceral relations |
| peritoneal folds | gastrophrenic ligament, gastrosplenic ligament, lesser omentum, and great omentum |
| gastrophrenic ligament | has 2 layers and attaches the fundus of the stomach to the diaphragm |
| gastrosplenic ligament | has 2 layers and attaches the body of the stomach to the spleen |
| lesser omentum | has 2 layers and attaches the lesser curvature of the stomach to the liver |
| greater omentum | has 2 layers and attaches the greater curvature of the stomach to the liver |
| how does the greater omentum protect against infection (policeman of the abdomen) | acts as a first line of defense by physically containing infections within the abdomen |
| where is the omental bursa (lesser sac) | behind stomach, behind gastrosplenic ligament, behind greater stomach, in front of great vessels and vertebral column |
| where does the omental bursa (lesser sac) and greater sac communicate | omental foramen |
| explain barium meal imaging in stomach | radio-opaque barium ingested to see peristaltic contraction of small intestine via narrowing in radiograph |
| anterior visceral relations in stomach is made of (3) | liver (left lobe), diaphragm and anterior abdominal wall |
| posterior visceral relations - structures in the stomach (6) | pancreas, splenic artery, left kidney, left adrenal gland, mesocolon, and spleen |
| superior visceral relation of stomach | oesophagus and left dome of diaphragm |
| main stomach blood supply | coeliac trunk |
| coeliac trunk | single midline trunk close to aortic hiatus (T12) and is the main artery supplying stomach |
| branches of celiac trunk include | right gastric (branching off to hepatic artery), right gastroepiploic (gastro-omental) branches of gastroduodenal artery), left gastroepiploic (branch of splenic artery), and short gastric (branches of splenic artery) |
| venous drainage of stomach | tributaries of portal vein |
| innervation/ nerve supply of stomach (2) | parasympathetic and sympathetic |
| parasympathetic nerves in stomach (2) | left and right vagus nerves |
| what do the left and right vagus nerves do in stomach | give rise to anterior and posterior vagal trunks respectively |
| due to rotation of gut, what happens to left and right sides of stomach | left vagus and side of stomach become anterior and right vagus and right side of stomach becomes posterior |
| anterior and posterior vagal trunks branch into | anterior and posterior gastric nerves |
| anterior gastric nerves gives branch to | pylorus and liver (through hepatoduodenal ligament) |
| sympathetic nerve supply in stomach | arises from T6-T9 spinal cord segments and passes to coeliac plexus via greater splanchnic nerve and carries some pain transmitting fibres |
| referred pain definition | aka reflective pain is pain perceived at a different location other than site of painful stimulus |
| referred pain in stomach | Visceral referred pain Visceral sensory fibers join spinal T6 - T9 T6-T9 dermatome Epigastric region Poorly localized |
| lymphatic drainage in stomach | coeliac lymph nodes around coeliac axis (T12) which drain to cisterna chyli-thoracic duct |
| where do lymphatic vessels and nodes follow | arteries like left/right gastric arteries, splenic artery running in gastrosplenic and lienorenal ligaments, right gastroepiploic artery in greater omentum |
| where could gastric carcinoma spread | through lymphatics |
| duodenum | shortest part of small intestine and is mostly retroperitoneal |
| parts of duodenum (4) | superior (intraperitoneal and retroperitoneal), descending, horizontal, and ascending |
| internal feature of first part of duodenum | smooth mucosal lining |
| internal feature of last parts of duodenum | mucosa with circular folds (plicae circulares) |
| bile duct and pancreatic duct empty into | medial wall of descending duodenum |
| opening of duct in duodenum forms | raised bump on mucosa aka major duodenal papilla |
| other internal features of duodenum | sometimes accessory pancreatic duct and minor duodenal papilla |
| relationships of duodenum (3) | superior part (L1), descending part (L2), horizontal part |
| superior part (L1) of duodenum includes | liver, gallbladder, hepatoduodenal ligament, and gastroduodenal artery |
| descending part (L2) of duodenum includes | head of pancreas, bile duct, and pancreatic duct |
| horizontal part (L3) of duodenum | lies over aorta/IVC and under superior mesenteric vessels |
| blood supply of duodenum includes (2) | superior pancreaticoduodenal artery (coeliac branch) and inferior pancreaticoduodenal artery (superior mesenteric artery) |
| superior pancreaticoduodenal artery | supplies duodenum above major papilla |
| inferior pancreaticoduodenal artery | supplies duodenum below major papilla |
| branches of superior mesenteric artery | supplies midgut from second part of duodenum to the left colic flexure |
| venous drainage in duodenum | via superior mesenteric vein which unites with splenic vein at the neck of the pancreas to form the hepatic portal vein |
| duodenum nerve supply | vagus nerve (CN X) via parasympathetic innervation and celiac plexus via sympathetic innervation |
| duodenum lymphatic drainage (2) | anterior and posterior drainage |
| anterior lymphatic drainage in duodenum | drains into pancreaticoduodenal lymph nodes and pyloric lymph nodes which are located along the arteries |
| posterior lymphatic drainage in duodenum | drains into the superior mesenteric lymph nodes and passes posterior to the head of the pancreas |
| jejunum features | heavily folded (plicae circulares) and have a lot of villi |
| where are plicae circulares most developed | in jejunum |
| describe the epithelium covering the villi in jejunum | simple columnar epithelium with cells that have microvilli on luminal surface which faces lumen |
| ileum | has plicae which become less and less obvious further down the small intestine and are absent in the lower part of the ileum. Villi also become shorter and less numerous. Lumen gradually narrows. |
| mesentery | double fold of peritoneal tissue that suspends small intestine and large intestine from posterior abdominal wall |
| how to identify jejunum in operation | by its location and by the arrangement of arteries in mesentery (arterial arcades are low with long terminal branches supplying intestine) |
| vasa recta | straight branches coming off arterial arcades |
| how to differentiate between jejunum and ileum | arrangement of arteries in mesentery - in the ileum the arterial arcades are heaped up and terminal arteries branches are short with a thinner wall than the jejunum. Ileum also has Peyer's Patches (lymphoid tissue) seen along the antimesenteric border. |
| ascending part of duodenum (L2) | runs along inferior border of pancreas and runs up to join duodenojejunal flexure which is held up by the ligament of Treitz (muscle strap derived from diaphragm and duodenum) |
| inferior pancreaticoduodenal artery | first branch of superior mesenteric artery which supplies the lower half of the duodenum |
| where do the jejunal and ileal arteries arise from | left side of SMA |
| where do the middle colic, right colic, ileocolic and appendicular arteries arise from | right side of SMA |
| describe the position of the branches suppling the large intestine | all the branches supplying the large intestine anastomose with one another EXCEPT the appendicular (end artery) |
| parasympathetic nerve fibres innervating duodenum originate from | anterior and posterior vagal trunks and pass through the celiac plexuses and synapse in the gut plexuses in the duodenum |
| sympathetic nerve fibres innervating duodenum originate from | T5 through T9 spinal cord levels |
| obstruction is characterised by | abdominal swelling, pain, vomiting, and constipation - and when untreated it can lead to dehydration and death |
| difference in terminal vessels and arterial arcades in jejunum and ileum | jejunum has long terminal vessels and low arterial arcades whereas the ileum has short terminal vessels and high 'heaped up' arterial arcades |
Created by:
22tango
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