Med Oradea - Anatomy II - Digestive System - Small Intestine (Duodenum, Jejunum, and Ileum) and Abdominal Wall
Has 4 parts
The first and third parts are retroperitoneal
Is situated in the supramezocolic space
Is fixed
Is shaped like a horseshoe with the opening to the left
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The duodenal bulb runs from the duodenopiloric incisure to the gallbladder
Has an upper, lower, and duodenojejunal flexure
Presents vertical folds on the interior
The greater duodenal papilla opens in the Vater's ampoule
Has relationships in its 3rd and 4th part with the root of the mezenterum in front (and the transverse colon)
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The greater duodenal papilla is in the lower part of a vertical fold
Vertical fold is determined by the Wirsung duct
The pancreatic duct unites with the Santonini duct
Intestinal villi are present at the distal part
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Presents 4 coats: serous membrane, muscular membrane, submucous, and mucous
Brunner glands are duodenal glands between the submucous and muscular membrane
Only the second, third, and fourth parts are retroperitoneal
The peritoneal membrane forms lunate folds (duodenal fossas) in the fourth part
The duodenal fossas are called the superior duodenal, inferior duodenal, retroduodenal, and duodeno-jejunal
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The liver is in front of the first and second part of the duodenum
The second part of the duodenum has relations behind with the coledoc duct, portal vein, and gastroduodenal artery
The liver is above the second part of the duodenum
Below the first part of the duodenum there is the pancreas, which is also medial to the second part
The inferior vena cava is behind the second and third parts of the duodenum
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In its first part, the pancreas below and the liver to the left
In its second part, the liver and ascending colon, laterally
In its third part, the aorta and uterus, behind
In its third part, mesenteric vessels in front
In its fourt part, the left kidney behind and laterally
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The gastroduodenal artery is a branch of the common hepatic
The fourth part of the duodenum has the stomach above and the aorta behind and medially
The aorta is behind the second part of the duodenum
The left kidney is lateral to the 3rd (transverse) and 4th (ascending) part of the duodenum
The stomach is above the 3rd and 4th part of the duodenum
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The veins of the duodenum go to the portal vein
The duodenum is supplied by the gastroduodenal and superior mesenteric arteries
The superior pancreaticoduodenal artery is from the superior mesenteric artery
The inferior pancreaticoduodenal artery is from the superior mesenteric artery
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Lymph drains to the hepatic and celiac lymph nodes
Parasympathetic innervation is from the celiac ganglia
Innervation is partly from thoracic splanchnic nerves
Thoracic splanchnic nerves are parasympathetic nerves which is why they don't synapse in the paravertebral ganglia
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Jejunum is fixed, ileum is mobile
Occasionally is partially outside the inframezocolic space
Jejunum and ileum don't have clearly defined limits, but jejunum is about 3/5 and ileum 2/5
Compared to the ileum, jejunum has more circular folds, is bigger, has more blood vessels, and is stronger
Peyer patches are found in the ileum and are lymphatic formations
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Together have transversal folds, but only the ileum has vertical folds
In front is the greater omentum
The omentum is also called the epiploon
Behind is the retroperitoneal space and posterior abdominal wall
Below is the bladder, rectum, and uterus (in women)
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The ascending and descending colon is lateral
Jejunum and ileum are connected to the posterior abdominal wall by a mesentery
This mesentery has an anterior (right) and posterior (left) surface
The mesentery has an intestinal border behind and a parietal border in front
Jejunum and ileum present circular folds in their mucous layer
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Present intestinal villi
Have 4 layers: serous, muscular, submucous, and mucous
The muscular layer is composed of an external circular layer and an internal longitudinal layer
The mucous layer has peyer patches in the ileum
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Receive blood from the superior mesenteric artery (a branch of the aorta) and the superior colic artery
The upper mesenteric vein drains them
Lymph goes to apical nodes and from there to cisterna chyli
Celiac and mesenteric plexuses supply innervation
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Receive innervation from the vagus nerve via the celiac plexus
The celiac plexus continues to the superior mesenteric plexus which surrounds the superior mesenteric artery
The vagus nerve joins the superior mesenteric plexus
The superior mesenteric plexus comes from the celiac plexus
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Is limited in the upper part by the costal arches and xiphoid process
Is limited in the lower part by a line connecting the inferior limit of the iliac crests
When divided into the system of 9 regions, the vertical lines are mid-axillary and the horizontal lines are bicostal and bicrestal
The bicrestal line connects the anterior end of the iliac fossa
The left hypochondriac region is in the second row
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The third row has the right and left iliac fossa
The hypogastric region is in the first row
The right and left epigastric regions are in the second row
The umbilical region is in the second row
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Serous coat is a visceral peritoneal membrane
Muscular coat has external longitudinal fibers
Has intestinal villi but these are absent in the first part of the duodenum and last part of ileum
Celiac plexus provides sympathetic innervation from the solar plexus
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