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  <head>
    <title>078-02 Oesophagus, stomach, small intestine, colon, rectum, and anorectal anatomy</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Gastrointestinal tract anatomy">
      <outline text="Abdominal oesophagus and junction">
        <outline text="Passes hiatus, joins stomach near T11"/>
        <outline text="Left vagus anterior, right posterior after rotation"/>
        <outline text="Junction support without a discrete ring">
          <outline text="Smooth-muscle tone, crura, angle of His"/>
          <outline text="Phrenooesophageal membrane, abdominal pressure"/>
        </outline>
        <outline text="Sliding hernia: junction moves upward"/>
        <outline text="Paraoesophageal hernia: stomach beside fixed junction"/>
        <outline text="Veins to left gastric and azygos">
          <outline text="Portosystemic site"/>
        </outline>
        <outline text="Lymph to mediastinum and left gastric nodes">
          <outline text="Longitudinal tumour spread"/>
        </outline>
      </outline>
      <outline text="Stomach">
        <outline text="Cardia, fundus, body, pyloric part"/>
        <outline text="Shape varies with filling, posture, body form"/>
        <outline text="Stomach bed behind lesser sac">
          <outline text="Pancreas, spleen, left kidney, adrenal"/>
          <outline text="Posterior ulcer can involve pancreas or splenic vessels"/>
        </outline>
        <outline text="Rich arterial anastomoses along both curvatures">
          <outline text="Short gastric branches supply fundus"/>
        </outline>
        <outline text="Lymph follows arteries toward coeliac nodes"/>
        <outline text="Vagus promotes motility and secretion"/>
        <outline text="Sympathetics via greater splanchnic, coeliac plexus"/>
        <outline text="Visceral pain refers to epigastrium"/>
      </outline>
      <outline text="Duodenum">
        <outline text="Four parts curving around pancreatic head"/>
        <outline text="Proximal intraperitoneal, rest secondarily retroperitoneal"/>
        <outline text="Superior part ulcer erodes gastroduodenal artery"/>
        <outline text="Descending part: major papilla">
          <outline text="Bile duct and main pancreatic duct enter"/>
          <outline text="Minor papilla for accessory duct"/>
        </outline>
        <outline text="Third part between superior mesenteric artery and aorta">
          <outline text="Compression can obstruct it"/>
        </outline>
        <outline text="Pancreaticoduodenal arcade marks foregut-midgut junction"/>
      </outline>
      <outline text="Jejunum and ileum">
        <outline text="Jejunum upper left, ileum lower right and pelvis"/>
        <outline text="Jejunum: thicker wall, longer vasa recta"/>
        <outline text="Ileum: more arcades, more mesenteric fat"/>
        <outline text="Mesenteric border receives vessels"/>
        <outline text="Ischaemia patterns differ by cause">
          <outline text="Embolus, thrombosis, low flow, venous, strangulation"/>
        </outline>
        <outline text="Lacteals carry chylomicrons into lymph">
          <outline text="Long-chain lipids bypass portal transport"/>
        </outline>
        <outline text="Terminal ileum rich in lymphoid aggregates"/>
        <outline text="Ileocaecal valve limits reflux incompletely"/>
        <outline text="Mobility permits volvulus, internal herniation"/>
      </outline>
      <outline text="Caecum, appendix, and colon">
        <outline text="Appendix at convergence of three taeniae">
          <outline text="Position varies, altering symptoms and examination"/>
        </outline>
        <outline text="Appendicular artery is an end artery"/>
        <outline text="Ascending and descending colon retroperitoneal"/>
        <outline text="Transverse and sigmoid colon mobile on mesocolon"/>
        <outline text="Taeniae, haustra, appendices epiploicae identify colon"/>
        <outline text="Superior mesenteric: caecum to proximal transverse"/>
        <outline text="Inferior mesenteric: distal transverse to upper rectum"/>
        <outline text="Marginal artery and Riolan arc connect systems">
          <outline text="Watersheds at splenic flexure and rectosigmoid"/>
        </outline>
      </outline>
      <outline text="Rectum and anal canal">
        <outline text="Rectum begins near S3"/>
        <outline text="Peritoneal cover decreases by thirds"/>
        <outline text="Superior rectal vein to portal system"/>
        <outline text="Middle and inferior rectal veins to systemic">
          <outline text="Portal-systemic communication"/>
        </outline>
        <outline text="Pectinate line: embryological junction">
          <outline text="Above: columnar, visceral, internal iliac lymph"/>
          <outline text="Below: squamous, somatic, superficial inguinal lymph"/>
        </outline>
      </outline>
      <outline text="Sphincters and haemorrhoids">
        <outline text="Internal sphincter: smooth, involuntary tone"/>
        <outline text="External sphincter: skeletal, three parts"/>
        <outline text="Puborectalis sling maintains anorectal angle">
          <outline text="Relaxation and floor descent permit defecation"/>
        </outline>
        <outline text="Haemorrhoidal cushions aid continence"/>
        <outline text="Internal haemorrhoids less pain-sensitive"/>
        <outline text="External thrombosis below line is painful"/>
      </outline>
      <outline text="Enteric and extrinsic innervation">
        <outline text="Myenteric plexus coordinates motility"/>
        <outline text="Submucosal plexus regulates secretion and blood flow"/>
        <outline text="Vagus to foregut and midgut"/>
        <outline text="Pelvic splanchnic S2 to S4 to hindgut"/>
        <outline text="Sympathetics reduce motility, constrict vessels"/>
        <outline text="Pain afferents travel with sympathetics"/>
        <outline text="Pudendal pathways below pectinate line"/>
      </outline>
    </outline>
  </body>
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