THEP II: Stomach and Spleen Anatomy Quiz

Questions and Answers

Which part of the gastrointestinal tract is primarily responsible for mechanically breaking down food?

Duodenum

Mouth

Small intestine

Stomach (correct)

What is the primary function of hydrochloric acid (HCl) in the stomach?

To absorb nutrients

To protect the stomach lining

To chemically break down food (correct)

To facilitate peristalsis

Which of the following reflects the anatomical position of the stomach within the body?

Left hypochondrium & epigastrium (correct)

Right hypochondrium & epigastrium

Lower abdominal cavity

Center of the abdomen

Which structure is NOT part of the coeliac trunk's tributaries?

Superficial epigastric artery Signup and view all the answers

What is the anatomical term for the area where food enters the stomach?

Cardia Signup and view all the answers

What is the approximate length of the small intestine?

6 meters Signup and view all the answers

Which feature distinguishes the stomach from other parts of the gastrointestinal tract?

Additional oblique muscle layer Signup and view all the answers

At which anatomical structure does the oesophagus pierce the diaphragm?

T10 Signup and view all the answers

What is the location of the duodenum in relation to the transpyloric plane?

At the level of L1 Signup and view all the answers

Which part of the gastrointestinal tract is the largest in terms of length?

Small intestine Signup and view all the answers

What is the primary role of the oblique muscle layer found in the stomach?

Breaking down food both mechanically and chemically Signup and view all the answers

Which structure acts as the entry point for food into the stomach?

Cardia Signup and view all the answers

What is the combined length of the small and large intestines?

7.5 meters Signup and view all the answers

At what specific anatomical location does the oesophagus pass through the diaphragm?

T10 Signup and view all the answers

Which of the following best describes the primary function of the stomach in digestion?

Breaking down food into a semi-liquid form Signup and view all the answers

What type of epithelium is found in the lower esophagus?

Stratified squamous Signup and view all the answers

The Angle of His is important in forming which of the following?

Cardiac sphincter Signup and view all the answers

Which region of the stomach is primarily responsible for food entry?

Cardia Signup and view all the answers

What type of epithelium lines the stomach?

Simple columnar Signup and view all the answers

Which muscle layer is unique to the stomach?

Innermost oblique Signup and view all the answers

Which of the following forms a physiological sphincter at the junction of the esophagus and stomach?

Cardiac sphincter Signup and view all the answers

Which artery primarily supplies the fundus of the stomach?

Short gastric arteries Signup and view all the answers

The lesser omentum contains which of the following ligaments? (Select one)

Hepatogastric ligament Signup and view all the answers

Which structure forms the anterior boundary of the lesser sac (Omental Bursa)?

Lesser omentum Signup and view all the answers

Which artery is NOT a direct branch of the celiac trunk?

Superior mesenteric artery Signup and view all the answers

The superior mesenteric artery supplies which part of the gastrointestinal tract?

Duodenum (D1) Signup and view all the answers

How many layers does the greater omentum have?

Two Signup and view all the answers

What is the function of the rugae in the stomach?

Increase surface area Signup and view all the answers

Which vein drains blood from the lesser curvature of the stomach?

Portal vein Signup and view all the answers

The ligament of Treitz is associated with which part of the gastrointestinal tract?

Duodenum Signup and view all the answers

Which artery runs along the superior border of the pancreas?

Splenic artery Signup and view all the answers

Which ligament carries the short gastric and left gastroepiploic arteries to the stomach?

Gastrosplenic ligament Signup and view all the answers

Which structure is most likely to become infected when a posterior stomach ulcer perforates?

Lesser sac Signup and view all the answers

What is Troisier's sign indicative of?

Enlarged supraclavicular lymph node Signup and view all the answers

The sympathetic nerve supply to the stomach is primarily via:

Thoracic splanchnic nerves Signup and view all the answers

The hepatoduodenal ligament is part of which structure?

Lesser omentum Signup and view all the answers

What is the main arterial supply to the spleen?

Splenic artery Signup and view all the answers

What is the main function of the spleen?

Filtration of blood Signup and view all the answers

Which artery supplies the descending part of the duodenum (D2)?

Superior pancreaticoduodenal artery Signup and view all the answers

Where does the foramen of Winslow open?

Between the greater and lesser sacs Signup and view all the answers

The pyloric sphincter is located at which vertebral level?

L1 Signup and view all the answers

In which part of the duodenum are peptic ulcers most commonly found?

D2 Signup and view all the answers

Which of the following is a common cause of epigastric pain relieved by eating?

Duodenal ulcer Signup and view all the answers

The venous drainage of the greater curvature of the stomach mainly involves:

Short gastric veins and left gastroepiploic vein Signup and view all the answers

The splenic artery is a branch of which of the following arteries?

Celiac trunk Signup and view all the answers

Which ligament contains the splenic artery as it runs along the tail of the pancreas?

Splenorenal ligament Signup and view all the answers

The gastrosplenic ligament contains which of the following arteries?

Short gastric and left gastroepiploic arteries Signup and view all the answers

Which structures are found within the splenorenal ligament?

Splenic artery and vein Signup and view all the answers

What is the primary relationship of the splenic artery along its course?

It runs along the superior border of the pancreas Signup and view all the answers

Venous drainage from the lesser curvature of the stomach primarily flows into which vein?

Portal vein Signup and view all the answers

Which veins contribute to the venous drainage of the greater curvature of the stomach?

Left gastroepiploic and short gastric veins Signup and view all the answers

The venous drainage of the duodenum is primarily directed into:

Hepatic portal system Signup and view all the answers

The splenic vein receives venous blood from all the following except:

Greater curvature of the stomach Signup and view all the answers

The left gastric vein is associated with which clinical condition in portal hypertension?

Esophageal varices Signup and view all the answers

Which of the following structures directly drains into the portal vein?

Left gastric vein Signup and view all the answers

Venous blood from the fundus of the stomach primarily drains into which vein?

Short gastric veins Signup and view all the answers

In portal hypertension, the engorgement of which veins may lead to esophageal varices?

Left gastric vein Signup and view all the answers

Which vein forms at the junction of the superior mesenteric and splenic veins?

Portal vein Signup and view all the answers

What is the primary drainage pathway for the venous blood from the duodenum?

Into the portal venous system Signup and view all the answers

Where does the pre-pyloric vein of Mayo typically drain?

Portal vein Signup and view all the answers

Which of the following ligaments contains both the splenic artery and vein?

Splenorenal ligament Signup and view all the answers

The gastroepiploic veins are primarily involved in draining blood from which part of the stomach?

Greater curvature Signup and view all the answers

Venous drainage from the spleen primarily empties into which vein?

Splenic vein Signup and view all the answers

The anterior surface of the stomach is in contact with which of the following structures?

Abdominal wall and diaphragm Signup and view all the answers

The posterior surface of the stomach is related to all of the following except:

Right lobe of the liver Signup and view all the answers

Which surface of the liver is in direct contact with the diaphragm?

Superior surface Signup and view all the answers

The greater omentum is attached to which surface of the stomach?

Greater curvature Signup and view all the answers

The spleen is located deep to which ribs?

9-11 Signup and view all the answers

The lesser sac (omental bursa) is situated behind which surface of the stomach?

Posterior Signup and view all the answers

The superior border of the pancreas is in contact with which of the following structures? A. Lesser omentum B. Greater omentum C. Splenorenal ligament D. Gastrosplenic ligament

Lesser omentum Signup and view all the answers

Which surface of the duodenum is in contact with the pancreas?

Posterior surface Signup and view all the answers

The surface of the liver that forms the boundary of the omental bursa is the:

Visceral surface Signup and view all the answers

Which structure is located on the posterior surface of the stomach and is involved in peptic ulcer complications?

Pancreas Signup and view all the answers

The greater sac of the peritoneal cavity is primarily located:

Beneath the diaphragm Signup and view all the answers

The anterior surface of the duodenum is in contact with which of the following structures?

Abdominal wall Signup and view all the answers

The left gastroepiploic artery supplies the surface of the stomach along which curvature?

Greater curvature Signup and view all the answers

The angle of His is formed by the junction of which two structures?

Esophagus and stomach Signup and view all the answers

Which nerve pathway is responsible for the sympathetic supply to the stomach?

Thoracic splanchnic nerves via the celiac plexus Signup and view all the answers

What is the significant clinical presentation difference between duodenal and stomach ulcers?

Duodenal ulcers cause pain relieved by eating. Signup and view all the answers

Which of the following correctly describes the anatomical length and division of the duodenum?

D1 is 2 inches, D2 is 3 inches, D3 is 4 inches, D4 is 1 inch. Signup and view all the answers

What is the function of the spleen in the context of blood filtration?

It filters blood, removing some pathogens. Signup and view all the answers

Which artery supplies the proximal portion of the duodenum up to the Major Duodenal Papilla?

Gastroduodenal artery Signup and view all the answers

Which ligament is associated with the splenic artery and vein?

Splenorenal ligament Signup and view all the answers

What is a potential consequence of hiatal hernia associated with gastroesophageal reflux?

Movement of the squamocolumnar junction Signup and view all the answers

Which anatomical relationship is correct regarding the duodenum?

D2 receives bile and is at the L2 level. Signup and view all the answers

Which structure is primarily involved in the drainage of gastric lymphatics?

Celiac lymph nodes Signup and view all the answers

Which of the following arteries branches from the celiac trunk?

Splenic artery Signup and view all the answers

What anatomical feature distinguishes the lower esophagus from the rest of the esophagus?

Transition from stratified squamous to columnar epithelium Signup and view all the answers

Which region of the stomach is responsible for churning food as part of mechanical digestion?

Body Signup and view all the answers

What is the primary function of the cardiac sphincter?

Control the entry of food into the stomach Signup and view all the answers

Which artery supplies the lower lesser curvature of the stomach?

Right gastric artery Signup and view all the answers

What anatomical structure is located behind the stomach and may be affected by posterior ulcers?

Lesser sac Signup and view all the answers

What role does the greater omentum play in relation to the stomach?

Forms a large fatty covering and stores fat Signup and view all the answers

Which structure forms the anterior boundary of the lesser sac?

Stomach Signup and view all the answers

What is the significance of the pyloric sphincter in gastrointestinal physiology?

Regulates the exit of chyme into the duodenum Signup and view all the answers

Which of the following statements accurately describes the blood supply to the stomach?

The celiac trunk supplies arterial blood to the stomach Signup and view all the answers

What is the anatomical significance of the squamocolumnar junction?

It represents the transition from stratified squamous to columnar epithelium. Signup and view all the answers

Study Notes

Gastrointestinal Tract - Anatomy Overview

Mouth, Pharynx, and Esophagus

Esophagus:
- Passes through the diaphragm at the T10 level.
- Stratified squamous epithelium transitions to columnar epithelium in the lower esophagus (Squamocolumnar Junction).
- Hiatal Hernia: Can alter the normal anatomy of this junction.

Stomach

Location:
- Situated in the left hypochondrium and epigastrium.
Structure:
- Four regions:
  1. Cardia: Entry of food.
  2. Fundus: Upper part.
  3. Body: Main central region.
  4. Pyloric region: Includes the antrum and canal leading to the pyloric sphincter.
Muscle Layers:
- Outer Longitudinal Layer.
- Middle Circular Layer.
- Innermost Oblique Layer: Unique to the stomach, aids in mechanical digestion.
Lining:
- Epithelium: Simple columnar epithelium.
- Rugae: Folds that increase surface area.
Sphincters:
- Cardiac Sphincter: Controls food entry.
- Pyloric Sphincter: Strong sphincter that controls food exit into the duodenum (L1 level).
Functions:
- Mechanical Digestion: Churning of food.
- Chemical Digestion: Secretion of hydrochloric acid.
- Converts food into "chyme."

Stomach Relations

Anterior:
- Abdominal wall, costal margin, diaphragm, and left lobe of the liver.
- Anterior ulcers may perforate into these structures.
Posterior:
- Lesser sac, pancreas, splenic artery, spleen, left kidney, and adrenal gland.
- Posterior ulcers may lead to lesser sac abscesses or erosion into nearby structures (e.g., pancreas, splenic artery).

Omenta and Ligaments

Greater Omentum:
- Large fatty layer attached to the greater curvature.
- Contains greater sac and forms the lesser sac behind the stomach.
Lesser Omentum:
- Attaches to the lesser curvature.
- Contains the hepatogastric ligament and hepatoduodenal ligament.
- Lesser Sac: Space behind the stomach formed due to the stomach's 90-degree rotation during development.

Blood Supply

Arterial Supply:
- Foregut (Stomach to D2 of the duodenum): Supplied by the celiac trunk (T12).
  - Left Gastric Artery: Supplies the upper lesser curvature.
  - Common Hepatic Artery:
    - Right Gastric Artery: Supplies the lower lesser curvature.
    - Gastroduodenal Artery: Gives rise to the right gastroepiploic artery.
  - Splenic Artery:
    - Supplies the fundus via short gastric arteries and the upper greater curvature via the left gastroepiploic artery.
Venous Drainage:
- Lesser curvature veins drain into the portal vein.
- Greater curvature veins drain into the splenic vein and superior mesenteric vein (SMV).

Lymphatic Drainage

Gastric Lymphatics:
- Drain along the arteries to the celiac lymph nodes.
- Involves perigastric nodes and suprapancreatic nodes.

Nerve Supply

Autonomic Nervous System:
- Sympathetic: Through the celiac plexus at T12-L1 via thoracic splanchnic nerves.
- Parasympathetic: From the vagal trunks (anterior and posterior).
- Nerves of Latarjet: Run along the lesser curvature.

Duodenum

Length: 10 inches (25 cm) and divided into four parts:
1. D1 (Superior Part): 2 inches long, at L1.
  - Common site for peptic ulcers.
2. D2 (Descending Part): 3 inches long, at L2.
  - Receives bile and pancreatic ducts.
3. D3 (Horizontal Part): 4 inches long, at L3.
  - Crosses anterior to the aorta and IVC.
4. D4 (Ascending Part): 1 inch long, at L2.
  - Terminates at the duodenojejunal flexure.
Blood Supply:
- Proximal to Major Duodenal Papilla:
  - Celiac Trunk via gastroduodenal artery.
- Distal to Major Duodenal Papilla:
  - Superior Mesenteric Artery (SMA) via inferior pancreaticoduodenal artery.
Venous Drainage: Veins parallel the arteries, draining into the portal venous system.

Spleen

Location: Left hypochondrium, deep to ribs 9-11.
Size: 1x3x5 inches, weighing 7 ounces.
Function: Filters blood, removing old erythrocytes.
Blood Supply:
- Splenic Artery: Branch of the celiac trunk, runs along the tail of the pancreas within the splenorenal ligament.
Relations:
- Gastrosplenic Ligament: Contains short gastric and left gastroepiploic arteries.
- Splenorenal Ligament: Contains splenic artery and vein.

Clinical Points

Peptic Ulcer Disease:
- Stomach Ulcers: Present with epigastric pain worsened by eating.
- Duodenal Ulcers: Present with epigastric pain eased by eating.
Hiatal Hernia: Can cause the squamocolumnar junction to move, potentially leading to gastroesophageal reflux.
Portal Hypertension: May result in esophageal varices due to swollen submucosal veins.

Esophagus

Passes through the diaphragm at the T10 level.
Transitions from stratified squamous epithelium to columnar epithelium at the Squamocolumnar Junction.
Hiatal Hernia can disrupt the normal anatomy of this junction.

Stomach

Located in the left hypochondrium and epigastrium.
Composed of four regions:
- Cardia: Food entry point.
- Fundus: Upper section.
- Body: Central area.
- Pyloric region: Includes antrum and canal leading to pyloric sphincter.
Muscle Layers:
- Outer Longitudinal Layer, Middle Circular Layer, and Innermost Oblique Layer unique to the stomach, aiding in mechanical digestion.
Lined with simple columnar epithelium; features rugae (folds) that enhance surface area.

Sphincters

Cardiac Sphincter: Regulates food entry into the stomach.
Pyloric Sphincter: Strong sphincter controlling food exit into the duodenum at L1 level.

Functions of the Stomach

Mechanical digestion through churning.
Chemical digestion via hydrochloric acid secretion, converting food into chyme.

Stomach Relations

Anterior: Related to the abdominal wall, diaphragm, and left lobe of the liver; anterior ulcers can lead to perforations.
Posterior: Associated with the lesser sac, pancreas, spleen, left kidney, and adrenal gland; posterior ulcers can create abscesses or erosions.

Omenta and Ligaments

Greater Omentum: Fatty layer attached to the greater curvature, containing the greater and lesser sacs.
Lesser Omentum: Attaches to the lesser curvature with hepatogastric and hepatoduodenal ligaments.
Lesser Sac: Space behind the stomach formed by its developmental rotation.

Blood Supply

Foregut is supplied by the celiac trunk (T12).
Key arteries:
- Left Gastric Artery: Supplies upper lesser curvature.
- Common Hepatic Artery: Supplies lower lesser curvature through Right Gastric and Gastroduodenal artery.
- Splenic Artery: Supplies the fundus via short gastric arteries.
Venous Drainage:
- Lesser curvature veins drain into the portal vein.
- Greater curvature veins drain into splenic and superior mesenteric veins.

Lymphatic Drainage

Drains along the arteries to celiac lymph nodes, including perigastric and suprapancreatic nodes.

Nerve Supply

Sympathetic: Via celiac plexus at T12-L1 through thoracic splanchnic nerves.
Parasympathetic: From vagal trunks (anterior and posterior); Nerves of Latarjet run along the lesser curvature.

Duodenum

Length: 10 inches (25 cm) divided into four parts:
- D1 (Superior Part): 2 inches, located at L1, common site for peptic ulcers.
- D2 (Descending Part): 3 inches at L2, receives bile and pancreatic ducts.
- D3 (Horizontal Part): 4 inches at L3, crosses anterior to aorta and IVC.
- D4 (Ascending Part): 1 inch at L2, terminates at duodenojejunal flexure.
Blood Supply:
- Proximal to Major Duodenal Papilla: Celiac Trunk via gastroduodenal artery.
- Distal to Major Duodenal Papilla: Superior Mesenteric Artery via inferior pancreaticoduodenal artery.

Spleen

Location: Left hypochondrium, beneath ribs 9-11.
Size: Approximately 1x3x5 inches, weighing around 7 ounces.
Function: Filters blood, removing old erythrocytes.

Blood Supply to Spleen

Supplied by Splenic Artery, a branch of the celiac trunk, running along the pancreas' tail.

Relations of Spleen

Gastrosplenic Ligament: Contains short gastric and left gastroepiploic arteries.
Splenorenal Ligament: Contains the splenic artery and vein.

Clinical Points

Peptic Ulcer Disease:
- Stomach ulcers: Cause epigastric pain worsened by eating.
- Duodenal ulcers: Cause epigastric pain eased by eating.
Hiatal Hernia: Can move squamocolumnar junction, leading to gastroesophageal reflux.
Portal Hypertension: May result in esophageal varices due to swollen submucosal veins.

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Test your knowledge on the anatomy of the stomach and spleen, including their blood supply, lymphatics, and peritoneal attachments. This quiz will cover key learning outcomes from the GIHEP course at the Royal College of Surgeons in Ireland. Ideal for students preparing for their assessments under Dr. Ciara Murphy.