Week 5- foregut 1

Question 1

What makes up the foregut?

Answer 1

Distal oesophagus
Stomach
Proximal duodenum
Spleen
Liver
Part of pancreas

Question 2

Where does the foregut obtain its blood supply from?

Answer 2

Coeliac axis (level T12).

Question 3

Where does blood from the foregut drain to?

Answer 3

Portal vein

Question 4

Where does lymph from the foregut go?

Answer 4

Coeliac nodes (pre-aortic nodes at T12).

Question 5

Where are the attachments for the lesser omentum?

Answer 5

Liver to the lesser curvature of the stomach.

Question 6

Where are the attachments of the greater omentum?

Answer 6

Greater curvature of the stomach and hangs inferiorly.

Question 7

Is the stomach an intraperitoneal structure?

Answer 7

Yes.

Question 8

What are the layers of the stomach?

Answer 8

Serosa muscularis externa- made up of an outer longitudinal part, middle circular and inner oblique)
Submucosa
Mucosa

Question 9

Describe the areas of the stomach?

Answer 9

At the top- called the fundus.
Then the body
Then the pyloris.

Question 10

Where are the notches on the stomach?

Answer 10

Superiorly- cardiac notch

On the lesser curvature- angular notch.

Question 11

What are the folds within the stomach called?

Answer 11

Rugae.

Question 12

Where (using surface markings) would you find the stomach?

Answer 12

Between ribs 5-6.

Question 13

What does the coeliac axis split into?

Answer 13

The left gastric, splenic and common hepatic artery.

Question 14

Which arteries run along the greater curvature of the stomach?

Answer 14

The right and left gastro-epiploic arteries.

Question 15

Which arteries run along the lesser curvature of the stomach?

Answer 15

The right gastric (from the common hepatic) and left gastric. They anastomose.

Question 16

Which artery from the coeliac axis also supplies part of the distal oesophagus?

Answer 16

The left gastric.

Question 17

Which artery supplies the fundus of the stomach? Which artery is it a branch of?

Answer 17

The short gastric artery which is a branch of the splenic artery.

Question 18

Describe the venous drainage of the stomach?

Answer 18

The right and left gastric veins drain directly back into the hepatic portal vein.
The left gastro-epiploic vein and short gastric vein drain into the splenic vein and then into the portal vein.
The right gastroepiploic vein drains into the superior mesenteric then into the portal vein.

Question 19

Where are the gastro-epiploic arteries branches from?

Answer 19

Left- branch of the splenic

Right- branch of the gastroduodenal which is a branch of the common hepatic.

Question 20

Where would you find the coeliac lymph nodes?

Answer 20

At the root of the coeliac axis at T12.

Question 21

What other lymph nodes may the foregut drain too?

Answer 21

Gastro-omental, gastric pyloric, pancreatosplenic and pancreatoduodenal lymph nodes.

Question 22

Where does the lymph go from the coeliac nodes?

Answer 22

Goes into the cysterna chyli then to the thoracic duct.

Question 23

Which plexus does autonomic innervation to the stomach come from?

Answer 23

Coeliac plexus.

Question 24

Which nerves carry sympathetic fibres to the stomach?

Answer 24

greater-splanchnic nerves to the coeliac plexus.

Question 25

Where does the parasympathetic supply to the stomach come from?

Answer 25

Anterior and posterior vagal trunks. Posterior trunk goes to the coeliac plexus.

Question 26

Describe the shape of the duodenum and what it is in close relation too?

Answer 26

C shaped and surrounds the head of the pancreas.

Question 27

Describe the 4 areas of the duodenum?

Answer 27

1st- duodenal cap
2nd- descending part- entrance of bile and pancreatic ducts
3rd-transverse
4th- ascending to jejunum

Question 28

What are the folds on the inner surface of the duodenum called?

Answer 28

Plicae circularis.

Question 29

What is the name of the union of the common bile duct and the pancreatic duct?

Answer 29

Ampulla of Vater or hepatopancreatic ampulla.

Question 30

What sort of muscle makes up the sphincter of Oddi and ampulla of Vater?

Answer 30

Smooth muscle- not under conscious control.

Question 31

What is the sphincter of Oddi?

Answer 31

A sphincter that controls the flow of bile salts and pancreatic fluid into the duodenum.

Question 32

Where on the surface would you find the duodenum?

Answer 32

The transpyloric plane (between L1 and L2) is inline with the 1st part of the duodenum.

Question 33

Which artery supplies the proximal part of the duodenum?

Answer 33

Superior pancreatoduodenal artery (branch of gasproduodenal artery).

Question 34

Which artery supplies the distal part of the duodenum?

Answer 34

Inferior pancreatoduodenal artery (branch of superior mesenteric)

Question 35

Describe the venous drainage of the duodenum?

Answer 35

Superiorly- via superior pancreatoduodenal vein into portal vein.
Inferiorly- inferior pancreatoduodenal vein into portal vein.

Question 36

Describe the nervous supply to the duodenum?

Answer 36

Parasympathetics- vagus nerve

Sympathetics- greater and lesser splanchnic nerves.

Question 37

Where is pain from the duodenum referred too?

Answer 37

The epigastric region.

Question 38

Where does lymph from the duodenum drain?

Answer 38

Follows arterial supply so splits into two parts.
Proximal duodenum follow pancreatoduodenal nodes, gasproduodenal and pyloric nodes to the coeliac nodes at T12.
Distal parts follow pancreatoduodenal nodes to the superior mesenteric nodes at L1.