Exam 1 Combined

Extends from the ileocecal junction to the upper part of the anal canal

Where is the large intestine located?

Water, electrolytes, and vitamin K

What is absorbed in the large intestine?

Cecum

defined as large pouch forming the beginning of the large intestine, connected to it is small blind tube or diverticulum called appendix

Colon

divided into 4 distinct segments;ascending, transverse, descending, and sigmoid

Rectum

the pelvic part of the large intestine

Anal canal

the last subdivision of the large intestine

T10 umbilical region

referred pain from the appendix can be felt in what region?

RLQ

the get a positive Blumberg's sign, you must palpate at the McBurney's located in the :

ileocecal junction

where do the large intestines begin?

Cecum

identify the structure

Ileocecal junction

identify the structure

appendix

identify the structure

ascending colon

identify the structure

right colic (hepatic) flexure

identify the structure

transverse colon

identify the structure

left colic flexure

identify the structure

descending colon

identify the structure

sigmoid colon

identify the structure

Mesentery of small intestine

identify the structure

Ileum

identify the structure

Lymphoid tissue, naturalizes pathogens

What does the appendix contain?

Appendicitis

What is the most common cause of surgery in the abdomen?

epiploic appendages

identify the structure

small, fat filled pouches

What are epiploic appendanges?

teniae coli

identify the structure

Teniae coli

3 longitudinal smooth muscular bands. Not present in

rectum or anal canal

haustra

identify the structure

Haustra

sacculations of the colon from the tightening of the teniae coli

Mass movements (peristaltic contractions): The circular muscles contract simultaneously with the teniae coli of the colon wall to move the colon contents a considerable distance toward the anus

What are the mass movements (peristaltic contractions) of the large intestine?

superior mesenteric a. (SMA)

inferior mesenteric a. (IMA)

what main abdominal arteries supply the large intestine?

ileocolic a.

right colic a.

middle colic a.

name the 3 arteries that branch from the SMA to supply the large intestine:

left colic a.

sigmoid aa.

superior rectal a.

name the 3 arteries that branch from the IMA to supply the large intestine:

Right colic artery

Identify the structure at #1

Ileocolic artery

Identify the structure at #2

Superior mesenteric artery

Identify the structure at #3

Middle colic artery

Identify the structure at #4

Marginal artery

Identify the structure at #5

Inferior mesenteric artery

Identify the structure at #1

Left colic artery

Identify the structure at #2

Inferior mesenteric artery

Identify the structure at #3

Sigmoid artery

Identify the structure at #4

Superior rectal artery

Identify the structure at #5

sigmoid artery

Identify the structure at #6

rectal folds (superior, middle, inferior)

these structures help maintain the fecal content inside the rectum

marginal a.

what artery anastamoses and connects the arterial supply from the SMA and IMA?

superior mesenteric v.

venous drainage for the midgut portion of the large intestine:

inferior mesenteric v.

venous drainage for the hindgut portion of the large intestine:

hepatic portal v.

to reach the portal venous system, the superior mesenteric v. will drain into the:

splenic v.

to reach the portal venous system, the inferior mesenteric v. will drain into the:

Splenic v.

Identify the structure

Portal vein

Rule of thumb: All blood from the gut should go to the liver through the...

cisterna chyli

lymph nodes surrounding the celiac trunk, SMA and IMA will drain into the:

thoracic duct

the cisterna chyli drains lymph received from abdominal nodes into the:

Celiac --> foregut

Superior mesenteric --> midgut

Inferior mesenteric --> hindgut

All of the lymph nodes report to major lymph nodes:

Celiac -->

Superior mesenteric -->

Inferior mesenteric -->

Celiac lymph nodes

What lymph do the stomach, liver, spleen, and pancreas drain into?

Superior and inferior mesenteric

What lymph do the intestines drain into?

Upper

Where are the anal columns located in the anal canal?

pectinate line

the inferior border of the anal columns demarcate the:

pectinate line

what line separates upper anal canal from lower anal canal?

anorectal junction

the superior border of the anal columns demarcate the:

involuntary (somatic)

the internal anal sphincter is under what muscular control?

voluntary

the external anal sphincter is under what muscular control?

endoderm

the upper anal canal originates from what embryonic layer?

Internal anal sphincter

Under involuntary control, modified extension of the circular muscles of rectum. Relaxes to allow defecation, constricts to maintain fecal continence

External anal sphincter

Under voluntary control, relaxation allows defecation, constricts to maintain fecal continence

ectoderm

the lower anal canal originates from what embryonic layer?

Endoderm

The upper anal canal originates from what embryonic layer?

pectinate line

the embryological anal membrane will turn into the:

superior rectal a.

the upper anal canal receives blood from the:

inferior mesenteric a.

the superior rectal a. is a branch of the:

haemorrhoids

In their normal state, they are cushions that help with stool control. They become a disease when swollen or prolapsed

middle rectal a.

inferior rectal a.

the lower anal canal receives blood from the:

superior rectal vein to the inferior mesenteric v.

the upper anal canal venous drainage is done by:

middle rectal v.

inferior rectal v.

the lower anal canal venous drainage is done by:

internal iliac v.

the middle rectal v. and inferior rectal v. drain into the:

internal iliac a.

the middle rectal a. and inferior rectal a. branch from the:

Left gastric vein

Which of the following veins is involved in the formation of esophageal varices as part of a portacaval anastomosis?

Superior rectal vein and inferior rectal vein

Anorectal varices result from increased pressure in the portal system. Which veins are primarily involved in this anastomosis?

internal iliac nodes

inferior mesenteric nodes

lymph drainage for above the pectinate line travels to:

superficial inguinal nodes

lymph drainage for below the pectinate line travels to:

abdominal lymph nodes, such as the inferior mesenteric and internal iliac nodes.

Pathology above the pectinate line (upper anal canal) will tend to spread to the...

picked up by the superficial inguinal lymph nodes

Pathology below the pectinate line (lower anal canal) will be...

pudendal n. (S2-S4)

somatic motor to external anal sphincter and somatic sensory to skin around the anal region is done by:

Autonomic and visceral sensory innervation

What type of innervation is found above the pectinate line in the anal canal?

intestinal mucosa

false diverticula involve swelling of only:

entire intestinal wall

true diverticula involve:

Sigmoid colon

What is the most common location for diverticula to develop in the colon?

volvulus of Sigmoid Colon

Rotations and twisting of the mobile loop of the sigmoid colon:

family history, IBD, old age, African American race, low-fiber diet, alcohol, smoking, obesity

risk factors for colorectal cancer

colonoscopy

diagnosis for colorectal cancer:

Surgery, chemotherapy, radiation

Three primary treatment options for colorectal cancer:

Crohn's Disease

patient presents to your office with •Cobblestonning of buccal mucosa and gingiva, Aphtous ulcers and Mucosal tags. Patient has a history of abdominal pain and sudden weight loss. What might be the diagnosis?

Diffuse labial, gingival or mucosal swelling Cobblestonning of buccal mucosa and gingiva

Aphtous ulcers

Mucosal tags

Pyostomatitis Vegetans

Angular cheilitis

Oral manifestations from Crohn's disease:

B) It is foregut structure

Which of the following statement is correct regarding the marked structure:

A) Received its blood supply from the superior mesenteric artery

B) It is foregut structure

C) Receives blood supply from both celiac trunk and SMA

D) It is retroperitoneal

A) Esophageal varices- Systemic hypertension

They are typically associated with portal hypertension

Which one of the following pairings is INCORRECT

A) Esophageal varices- Systemic hypertension

B) Duodenum-Retroperitoneal space

C) Ampulla of Vater- Head of pancreas

D H. Pylori. Peptic ulcer disease

False

T/F: One of these structures are mislabeled

D) Rectum-Tenia Coli

Which one of the following pairs don't fit together

A) Transverse colon-Mesocolon

B) Crohn's disease-Ileocecal junction

C) positive Blumberg's sign-Appendicitis

D) Rectum-Tenia Coli

B) SMA

C) Marginal artery

5) This part of the Gl tract receives blood supply from (check all that applies):

A) Gastroduodenal artery

B) SMA

C) Marginal artery

D) Superior Pancreaticoduodenal

A) Internal anal sphincter-puborectalis muscle (internal anal sphincter is smooth muscle controlled by ANS and puborectalis is skeletal muscle)

D) Anal canal below pectinate line- Portal vein (should be inferior rectal vein)

Which of the following pairings is incorrect (check all that applies)

A) Internal anal sphincter-puborectalis muscle

B) Upper part of anal canal- Hindgut

C Rectum-Superior rectal artery

D) Anal canal below pectinate line- Portal vein

Pudenal nerves

The picture depicts an anal fissure, a painful tear in the lining of the anus: what nerve supply somatic sensory fibers to this