SEM 2: abdo IV

?
what is omphalocele
gut contents protrude from umbilical ring due to a malrotation of the gut and failure of the rectus abdominus to develop correctly
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what is meckle's diverticulum
a failure of the viteline duct to degenerate in the 9th week, causing the ileum to outpouch which can result in gastric or pancreatic cells becoming ulcerated and painful
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what is the structure of the lumen of the jejunum and ileum
highly folded (plicae circulares -> villi -> micro villi)
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where does the small intestine start and end?
duodenojejunal flexure (held upwards by ligaments or treitz) to ileocecal junction
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what are the contents and relations of the mesentery around the small intestine
ileum and jejunum are intraperitoneal, mesentery contains : superior mesenteric a., superior mesenteric v., lymph nodes, fat, autonomic ns. root attaches to posterior body wall obliquely
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how does the wall and lumen of the ileum and jejunum compare
jejunum: thick walls, wide lumen with dense plicae circulares. ileum: thin walls, narrow lumen with sparse plicae circulares.
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how does the blood supply of the ileum and jejunum compare
jejunum: greater blood supply, less arterial arcades, long vasa recta. ileum: less blood supply, more arterial arcades, short vasa recta.
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how does the surroundings of the ileum and jejunum compare
jejunum: fewer peyer's patches, less fat. ileum: many peyer's patches, more fat.
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where does the large intestine start and end
ileocecal junction to anus
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where are the paracolic gutters ands why are they clinical relevant
lateral to ascending and descending colons, they're continuous with sub-hepatic and hepatorenal recesses, hence infection can spread through these areas.
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what are the features of the large intestine
omental appendices (fat pouches around the outside), taeniae coli (three longitudinal bands of muscle that help with peristalsis, joining at appendix and form bunches called haustra)
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what are the relations of the caecum
ant.and lateral: right iliac fossa, inf.: opening of vermiform appendix, sup.: ascending colon, medial: iliocecal junction
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what is the blood supply to the caecum
iliocolic a. from superior mesenteric
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what is the relation between the appendix and the peritoneal
intraperitoneal - mesoappendix
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what is the position of the appendix
retrocecal (behind caecum), subcecal (bellow caecum), pelvic (into pelvis), pre-ileal (ant. to ileum), post-ileal (post. to ileum)
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what is the blood supply to the appendix
appendicular a. from ileocolic
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what is appendicitis
inflammation of appendix stretching visceral peritoneal, causing pain in the periumblical region (T10) and later, irritates parietal peritoneum causing pain in lower right quadrant.
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where is mcburneys point and what is its clinical relevance
lateral 1/3 of line from ASIS to umbilicus, usually origin of appendix for surgery
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what are the relations of the ascending colon
inf. ileocolic junction and caecum, sup. hepatic flexure, ant. peritoneum (2ndary retroperitoneal), lat. right paracolic gutter
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what are the relations of the transverse colon
intraperitoneal within transverse mesocolon, runs hepatic flexure to splenic flexure
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what is the significance of the transverse colon
boundary of the midgut and hindgut 2/3rds across = blood supply from superior mesenteric to inferior mesenteric, parasympathetic. innervation from vagus to pelvic splanchnic (s2-4), sympathetic innervation from lesser splanchnic to lumbar splanchnic.
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what is the significance of the transverse mesocolon
divides abdomen into supra colic and infra colic, contains middle colic a., posteriorly joins to body wall, anterior layer joins to greater omentum.
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what is the marginal artery of Drummond
an anastomeses of superior and inferior mesenteric a. = collateral for blockages - prevents ischemia
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what are the relations of the descending colon
sup. splenic flexure, inf. sigmoid colon, 2ndary retroperitoneal, lat. left paracolic gutter
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what are the relations of the sigmoid colon
intra peritoneal, ends at s3
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where is the root of the sigmoid mesocolon
left iliac fossa s3
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what is diverticulosis
out pouching of the colonic mucosa and submucosa through weaknesses of the muscle layers, where undigested food and faeces can accumulate
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what is diverticulitis
infections and inflammation of the diverculum, usually at the sigmoid colon
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what's the relations of the rectum
post. s3 , inf. levator ani
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what are the transverse rectal folds
thickening circular muscle layer of rectum wall joining to make triangle ridges
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what is the ampulla's function
the most inferior part of the rectum that can expand, allowing the accommodation of faeces
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what is the function of the Levi ani muscle
continence, forms the pelvic diaphragm
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what is the function of the puborenalis muscle
wraps around the rectum to stop the flow of faeces
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what is the relevance of the bend of the rectum
helps with continence
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how does the epithelium differ superior and inferior to the pectinate line
superior: columnar, inferior.: stratified squamous
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how does the blood supply differ superior and inferior to the pectinate line
superior: superior rectal from inferior mesenteric and middle rectal from internal iliac, inferior.: inferior rectal from internal pudenal
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how does the venous drainage differ superior and inferior to the pectinate line
superior: superior rectal to inferior mesenteric to hepatic portal system, inferior.: inferior rectal to internal pudenal then inferior rectal and middle rectal to internal iliac
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how do the nerves differ superior and inferior to the pectinate line
superior: inferior hypogastric (ANS) inferior.: inferior rectal (somatic)
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how does the lymph drainage differ superior and inferior to the pectinate line
superior: internal iliac inferior.: superficial inguinal
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what is the innervation of the internal anal sphincter
involuntary autonomic control by pelvic splanchnic
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what is the innervation of the external anal sphincter
voluntary somatic control by inferior rectal
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what is the arterial supply to the hindgut
inferior mesenteric -> left colic (1/3rd transverse colon), sigmoid, superior rectal
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what are haemorrhoids
dilated/varicose veins -> engorged venous plexus = v. painful if prolapse or occurring bellow pectineal line
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the sympathetic ns is...
thoracocolumnar (T1-L2)
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the parasympathetic ns is...
craniosacral (CN III,VII,IX, X and S2-4)
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what is referred pain
sympathetic nerves travel with visceral afferent fibres from visceral peritoneum and somatic sensory nerves for dermatome, close relation means signals from visceral afferent intrpreted as pain from dermatome. always central.
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Card 2

Front

what is meckle's diverticulum

Back

a failure of the viteline duct to degenerate in the 9th week, causing the ileum to outpouch which can result in gastric or pancreatic cells becoming ulcerated and painful

Card 3

Front

what is the structure of the lumen of the jejunum and ileum

Back

Preview of the front of card 3

Card 4

Front

where does the small intestine start and end?

Back

Preview of the front of card 4

Card 5

Front

what are the contents and relations of the mesentery around the small intestine

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Preview of the front of card 5
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