[ANA] UPPER GASTROINTESTINAL TRACT

pharynx (hypopharynx)

The esophagus joins which structure (be specific) to the stomach

cervical, thoracic, and abdominal

Enumerate the three parts of the esophagus

right crus of the diaphragm

The abdominal portion of the esophagus enters which structure

TV10

The esophageal opening where the esophagus enters in the diaphragm lies at which level?

Esophageal Constrictions

These sites are where lodgment of foreign body, delay of passage of fluid (caustic substance), site of stricture formation, and carcinoma formation are located

First EC (CERVICAL / CRICOPHARYNGEAL)

Esophageal constriction where the pharynx joins the upper esophageal end

Cricopharyngeus muscle

Muscle found at the first esophageal constriction

2nd EC (AORTOBRONCHIAL / BROCHOAORTIC)

Esophageal constriction where crossing by the aortic arch, the left primary bronchus is located

aortic arch, left primary bronchus

The 2nd EC is located at which crossing of structures

3rd EC (LOWER THIRD / DIAPHRAGMATIC)

Esophageal constriction where the esophagus passes through the diaphragm

Vertically elongated / “J SHAPED”

Shape of the stomach in tall and thin individuals

High and transversely arranged STEERHORN

Shape of the stomach in short and obese individuals

epigastric area

The stomach extends from the LUQ to which area

Fundus

This is the most superior portion and dome-shaped part of the stomach

T

T/F: The fundus of the stomach is gas-filled, especially in an upright position.

cardiac/gastroesophageal orifice

The fundus of the stomach projects upward to the left of which structure

incisura angularis

The body of the stomach extends from the cardiac orifice to this structure, which marks the end of the body and beginning of the antrum.

Antrum (pyloric antrum)

Part of the stomach which extends from the incisura angularis to the pylorus

pyloric sphincter and canal

What are the two portions of the pylorus

transpyloric plane

The pylorus of the stomach lies on which plate

lesser omentum

The lesser curvature of the stomach is suspended from liver by which structure

Gastrosplenic omentum (ligament), Greater Omentum

What are the two omentum of the greater curvature of the stomach

Gastrosplenic omentum (ligament)

This omentum connects the upper curvature to the spleen

left gastroepiploic and the short gastric vessels

The gastrosplenic omentum (ligament) contains which vessels?

Lower greater curvature to the transverse colon

The greater omentum is kept in place from the connection of which two structures

D1: PARS SUPERIORIS

This is the only intraperitoneal part of the duodenum

D2: PARS DESCENDENS

This segment/part of the duodenum contains the pancreatic and bile duct openings

Duodenal papilla

This structure is found at the medial border of D2

F: D3 is the horizontal part (Pars Horizontalis) while D4 is the ascending part (Pars Ascendens)

T/F: D3 is the ascending part (Pars Ascendens) while D4 is the horizontal part (Pars Horizontalis)

Ligament of Treitz

Suspensory ligament of the duodenum at the terminal portion of D4

T

T/F: Ligament of Treitz fixes the duodenojejunal flexure to the right crus and marks the beginning of the lower GI tract.

beyond D2

When the patient vomits, if you see green, the source of obstruction is?

superior to the D2

If vomit is clear or straw-colored or yellow, the source of obstruction is

1st inch (D1)

The entire duodenum is fixed to the posterior abdominal wall except which part

F: retroperitoneum

T/F: D2-D4 are fixed in the intraperitoneum, so they are not that susceptible to movement force.

Longitudinal folds

Type of folds in the mucosa and submucosa of the esophagus when empty (temporary)

RUGAE

What do you call the longitudinal folds in the mucosa and submucosa of the stomach when empty, which also serve to increase surface area when in contact with food

PLICAE CIRCULARES

If the mucosal lining of D1 is smooth, what are the permanent circular folds that line the mucosal lining of D2-D4

medial border of D2

The two openings of the duodenum is located at

Major duodenal papilla

Opening of the duodenum where ampulla of the main pancreatic duct and the common bile duct drain into

Minor duodenal papilla

Opening of the duodenum where the site of drainage of the accessory pancreatic duct is located

Physiologic sphincter (due to the circular muscle of the esophageal wall)

What type of sphincter is gastroesophageal junction/sphincter (GEJ)

Tonic contraction

What kind of contraction does GEJ function to under vagal control

T/F: The pyloric sphincter is only an anatomic sphincter

F: The pyloric sphincter is both an anatomic and physiologic sphincter

Superior to D1

The epiploic foramen is found relatively to which part of the duodenum

lesser sac and greater sac

The epiploic foramen connects what two structures

Epigastric, LUQ

Location of the esophagus

Left vagus (anterior vagal trunk)

Structures anterior to the esophagus

Right vagus (posterior vagal trunk)

Structures posterior to the esophagus

LUQ, epigastric and umbilical region

Location of the stomach

antrum and pylorus areas

The stomach may extend to the epigastric region at which area/s

in children, if full, during eating or after a meal

The stomach may extend to the umbilical region in/if

Anterior Abdominal wall

Structures anterior to the stomach

Lesser sac, splenic artery, pancreas

Structures posterior to the stomach

epigastric and umbilical region

Location of the duodenum

Transpyloric plane ( at the level of pylorus), LV1

Location of D1

Right side of LV2-LV3

Location of D2

Subcostal plane

Location of D3

Lesser sac, splenic artery, pancreas

Structures anterior to the duodenum

gallbladder

Structures anterior to D1

transverse colon

Structures anterior to D2

Roots of the mesentery w/ Superior Mesenteric vessels

Structures anterior to D3

lesser sac (1st inch), Gastroduodenal artery (GDA)

Structures posterior to D1

Hilum of Right kidney

Structures posterior to D2

IVC, Right Psoas

Structures posterior to D3

Left margin of aorta, Left Psoas

Structures posterior to D4

acid and pepsin

The mucous membrane and the fundus of the stomach produce which secretions

antrum and pylorus

Alkaline secretion is produced in which part of the stomach

the greater sac

Anterior wall perforation in gastric ulcer causes spillage of gastric contents into?

lesser sac, pancreas

Posterior wall perforation in a gastric ulcer causes spillage of gastric contents into [1] and adheres to which structure [2]?

splenic artery

This is a vessel that is invaded in the posterior wall perforation in a gastric ulcer that may cause massive bleeding

D1 (anterolateral wall)

Duodenal ulcer is commonly located at which segment of the duodenum

Gastroduodenal artery

Posterior perforation in duodenal ulcer may erode which vessel that may cause massive bleeding

Inferior thyroid artery (O: Thyrocervical Trunk)

Arterial supply of the Cervical Esophagus and its Origin

Descending thoracic aorta

Arterial supply of the Thoracic Esophagus

Esophageal branches from the Left Gastric a.

Arterial supply of the Abdominal Esophagus

Abdominal Aorta

What is the Origin of the Left Gastric a.

Inferior Thyroid Vein

Drainage of Cervical Esophagus

Azygous vein

Drainage of Thoracic Esophagus

Left Gastric v.

Drainage of Abdominal Esophagus

Portal Vein

Left Gastric vein drains to

Celiac Nodes

Left Gastric Nodes that drain the Esophagus drains to?

Deep Cervical nodes

What is the lymphatic drainage of Cervical Esophagus

Superior and posterior mediastinal nodes

What is the lymphatic drainage of Thoracic Esophagus

L & R Gastric a., L & R Gastroepiploic a., Short Gastric a.

Enumerate the arterial supply of the stomach (5)

O: Celiac a.

S: lower 3rd esophagus, upper R stomach

Origin of L. Gastric a. and which structure does it supply to?

O: Hepatic a.

S: upper border pylorus, lower right stomach

Origin of R. Gastric a. and which structure does it supply to?

Short Gastric a. (fundus), L. Gastroepiploic a. (upper greater curvature)

Which two branches that supply the stomach has its origin from the Splenic artery?

O: Gastroduodenal Artery

S: Lower part of the greater curve of the stomach

The R. gastroepiploic artery supplies which part of the stomach and what is its origin?

Portal Vein

Left and Right Gastric Vein drain to

Splenic vein → Portal Vein

Short Gastric Vein and Left Gastroepiploic Vein drain to

Superior Mesenteric Vein → Portal Vein

Right Gastroepiploic Vein drains to

Celiac nodes

Main lymphatic drainage of the stomach

Superior pancreaticoduodenal Artery

Which supplies the upper half of the duodenum

Gastroduodenal Artery

Origin of Superior pancreaticoduodenal Artery

Inferior pancreaticoduodenal artery

Which supplies the lower half of the duodenum

Superior Mesenteric Artery

Origin of Inferior pancreaticoduodenal Artery

Portal Vein

Veins of the duodenum (of same name) drains into

Pancreaticoduodenal nodes → GDA → Celiac Nodes

Extension of the lymphatic drainage of the Upper half duodenum