Stomach, Duodenum and Pancreas
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| What part of the gut is stomach? Duodenum and Pancreas? | Stomach is foregut, Duodenum is half foregut and half midgut and Pancreas develops at junction between foregut and midgut
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| Where can ventral mesentery be found in the foregut? | Ventral mesentery extends to the top of the duodenum. Ventral mesentery can be found between the anterior body wall and liver
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| Where is the ligamentum teres hepatis? | It is at the free edge of the falciform ligament
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| What region can the developing liver be found? | In the region of the septum transversum
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| Name the divisions of the stomach | Fundus, Cardiac part, body, pylorus antrum, pyloric canal, pylorus
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| What is the proximal end of the stomach attached to? | It is attached to the esophagus at the esophagogastric junction
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| How does the epithelium change between stomach and esophagus? | There is an apparent zig zag line
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| What marks the distal end of the stomach? | The distal end of the stomach is marked by the pylorus which connects the stomach to the duodenum
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| What is the pylorus? | It is a very tight sphincter because at that point you want to eject the acidic contents of the stomach in a very regulated manner into the first part of the duodenum
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| Does the pH change at the duodenum? What is introduced here? | Yes, it is where the pH chnages and bile acids and pancreatic enzymes are introduced
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| What is the pyloric antrum? | It is a functional demarcation where the muscles tend to form a stricture around the back
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| Where does the pyloric canal and the the pyloric antrum end? | They end at the pylorus
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| Where does the stomach lie? | It lies on the stomach bed and the pancreas is included
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| What happens when there is inflammation in the stomach? | It appears as if it is coming from the heart. Visceral afferents give the impression of an angina attack or myocardinal infarction
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| What is reflux gastritis? | When fluid come back into the esophagus
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| Where does the pylorus enter the duodenum? | It enters through the duodenal cap
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| Different parts of the stomach have.... | Different functions
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| Where do fluids go in the stomach? | They come down the cardiac orifice into the gastric cancal or magenstrasse
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| What is in the gastric canal that allow fluids to flow down? | There are longitudinal folds allowing water to percolate down the lesser curvature into pyloric orifice
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| Where do semi-solids and solid go in the stomach? | They must churn with peptic enzymes in the acid pH environment of the gastric and fundic zones
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| Where does the esophagus enter the diaphragm? | At T 10
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| Why is the distal end of the stomach significantly anchored? | Because of the heptoduodenal ligament
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| At the esophagogastric junction there needs to be the ability to expand, how is this acheived? | You pack it with fat
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| What can happen when the esophagogastric junction is compromised? | You can have a hiatus hernia. Stomach can go into thorax
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| What is a sliding hiatus hernia? | Where the gastroesophageal junction moves above the diaphragm together with some of the stomach
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| What is a paraesophageal hiatus hernia? Does it need to be corrected? | Part of the stomach herniates through the esophageal hiatus and lies beside the esophagus without movement of the gasroesophageal junction. Most times do not need to be corrected
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| What is in the supracolic compartment? (above transverse colon) | The stomach, liver and spleen
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| What is the ends of the transverse colon demarcated by? | The left colic (splenic flexture) and the right colic (hepatic flexture)
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| What two components does the liver consist of from GI tract and septum transversum? | Epithelia (endothermal) coming from the GI tract and parenchymal cells from the cells of the septum transversum
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| What is the heptagastric ligament and the heptaduodenal ligament? | Heptagastric ligament: Expanse of ventral mesentery from liver to stomach. Heptaduodenal: Expanse of ventral mesentery from liver to duodenum
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| What is a ligament? | A thin sheet of peritoneum with two serous layers with some fat in between
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| Where does the spleen develop? | It develops in the dorsal meesentery and there is a gastrosplenic ligament connecting the spleen and the greater curvature of the stomach which is an extension of dorsal mesentery
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| What structures are in the hepatduodenal ligament? | The portal vein, the common bile duct and the hepatic artery proper
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| What is between the inferior vena cava and the heptaduodenal ligament? | The foramen of Winslow
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| What makes up the lesser omentum? | Two mesothelial sheets. It is attached from the lesser curvature of the stomach across the liver to the fissure for the ligamentum venosum
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| Where does the superior recess of the lesser sac run? | All the way up to the backside of the liver and it stops where the bare area of the liver begins
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| If you go behind the stomach where will you be stopped? | You will be stopped at the inferior recess of the omental bursa
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| What makes up the greater omentum? | 4 layers of peritoneum
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| Where is the bloodvessels located in abdomen? | On the posterior abdominal wall retroperitoneal
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| What branches does the celiac trunk break into? | Left gastric artery, splenic artery and common hepatic artery
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| Where does the splenic artery run? | Into the stomach bed along the superior border of the pancreas and reaches spleen through the splenorenal ligament to reach hilum
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| Where does the left gastric artery run? | Runs retroperitoneally and supplies left side of lesser curvature of stomach. Eventually becomes intraperitoneal. Branches go into esophagus at the same time
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| Where does the common hepatic artery go? | Reaches the lesser omentum where it breaks up and gives off hepatic artery proper and gastroduodenal artery
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| What does the gastroduodenal artery branch into? | The right gastroomental artery
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| Where does the right gastric artery come off and run to? | It comes off the hepatic proper and runs to the lesser curvature of the stomach to anastomose with left gastric artery
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| What does the right gastroomental artery anastomose with? | With the left gastroomental artery
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| What does the splenic artery branch into? | Branches into the short gastric artery and left gastroomental artery(gastroepiploic artery)
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| What does the left gastroomental artery supply? | The greater omentum on the left side
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| What supplies the fundus of the stomach? | The short gastric artery
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| Where does venous drainage end up? | The portal vein
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| What is the portal vein? | A remnant of the vitelline vein and the venous draingage ends up in the hepatic portal system
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| Where does venous return also come from? | the lower end of the esophagus that goes into the portal system and the azygos system. (secondary pathway if there is blockage)
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| What do the lymphatics follow? | The veins
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| Why do gastric cancer diagnosis tend to be late? | By the time the cancer invades the lymphatic to a size that they can be detected they could spread in mulitple different directions
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| What innervates the stomach? | The vagus nerve (parasympathetic motor). Sympathetic fibers coming from the celiac ganglion with presynaptic fibers from greater splanchnic nerves
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| Where is the pain referred when you have a gastric ulcer? | To the heart because of visceral afferents piggy-backing along the vagus and sympathetic paths
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| Where does the left vagus nerve go when it enters the abdomen? | The anterior vagul trunk into the esophageal plexus
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| Where does the right vagus nerve enter the abdomen? | Posteriorly on the posterior vagul trunk
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| What parts is the duodenum divided into? | 1st, 2nd, 3rd and 4th
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| Where does the first part of the duodenum run? | From the pylorus to the liver (intraperitoneal)
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| Where does the 2nd and third part of duodenum run? | 2nd: Inferiorly down on the side of vertebral column. 3rd: horizonal extension anteriorly to abdominal aorta. (secondary retroperitoneal)
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| 4th part of duodenum? | Anteriorly and is continous with the jejunum
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| What supplies blood to duodenum? | The gastroduodenal artery (from common hepatic from celiac trunk) and superior mesenteric artery
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| What does the gastroduodenal artery branch to? | The superior pancreaticoduodenal arteries that supply pancreas and duodenum
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| What does the superior mesenteric artery branch inot? | The inferior pancreaticoduodenal arteries that anastosome with the superior pancreaticoduodenal arteries
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| What are the folds inside the duodenum called? | Plicae circularies
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| What is the major duodenal papilla? | Where the common bile duct and Pancreatic duct come into the duodenum
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| What is the ampulla of vater? | Where the common bile duct and pancreatic duct open located at the major duodenal papilla
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| What is the ligament of Tretitz? | Where the duodenum is anchored to the posterior abdominal wall by a connective tissue that makes up a suspensory ligament
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| What does the dorsal pancreatic bud represent? | A tubular invagination of the endoderm into the dorsal mesentery
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| What does the ventral pancreatic duct open into? | The major duodenal papilla
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| What does the venral pancreatic bud develop into? | The head and uncinate process of pancreas
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| What does the dorsal pancreatic duct open into? | the minor duodenal papilla
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| What does the dorsal pancreatic bud develop into? | The body and tail of the pancreas
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| What do the splenic vein and superior mesenteric vein combine and become? | The hepatic portal vein
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| Where can the inferior mesenteric vein drain? | Anywhere, but most of the time into the splenic vein
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| What innervates the pancreas and duodenum? | Both parasympathetic and sympathetic innvervation
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| What regulates the sphincter of Oddi? | Opening and closing regulated by a peptide hormone cholecystokinin
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| What can pancreatic cancer lead to? | Obstruction of bile flow because common bile duct is close to head of pancreas. can manifest itself in jaundice
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| What is the sphincter of Oddi? | controls the opening of the major duodenal papilla
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