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11. GastroIntestinal Exam 1 > 4. GI Organs > Flashcards

4. GI Organs Flashcards

1
Q

The esophagus can be found around T10-11, the stomach at T11 and the pylorus at?

A

L1

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2
Q

The esophagus is 25cm long and passes through the right crus of the diaphragm at?

A

T10

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3
Q

It fits into a groove on the posterior liver and has anterior and posterior vagal trunks around it… It is attached to the diaphragm via what ligament?

A

The phrenicoesophageal ligament

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4
Q

There are many constriction points on the esophagus. The upper sphincter in the cervical region is due to the cricopharyngeus muscle. What constriction point is in the thoracic area?

A

The left main bronchus and the aorta constrict the esophagus here

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5
Q

The last two constriction point of the esophagus are the lower esophageal sphincter (LES) and the esophageal hiatus at T10. What pathology occurs here? (2)

A

Hiatal hernias: sliding and para esophageal

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6
Q

Hiatal hernias occur when abdominal structures enter the thorax, commonly on the left side. What occurs in a paraesophageal hernia?

A

The fundus of the stomach ONLY protrudes into thorax, with a normal gastroesophageal junction and no GERD

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7
Q

What occurs during the most common sliding hiatal hernia?

A

The cardia and fundus of the stomach protrude, presenting as an hour glass and with GERD

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8
Q

the stomach is not a fixed structure, meaning it can be very high or very low. What are the structures of the stomach from the esophagus to the duodenum? (5)

A

Cardia, Fundus, Body, Pyloric atrium, pyloric canal

greater and lesser curvature

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9
Q

What attaches to the lesser and greater curvature of the stomach respectively?

A

Lesser: superior border, lesser omentum
Greater: inferior border, greater omentum attaches here

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10
Q

The stomach lies on the transverse colon and anteriorly touches the diaphragm, left lobe of the liver, and anterior abdominal wall. What does the stomach come in contact with posteriorly? (6)

A 
Diaphragm
Spleen
Left upper kidney/suprarenal gland
Pancreas
Lesser sac (omental bursa)
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11
Q

What does the gastrohepatic and gastrocolic ligament connect to respectively?

A

Gastrohepatic connects to the lesser curvature of the stomach and liver
Gastrocolic connects to the greater curvature of the stomach and transverse colon

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12
Q

A duodenal ulcer typically occurs on the post wall of the 1st part of the duodenum. Causing hemorrhage from gastroduodenal A. Where does a gastric ulcer occur?

A

The lesser curvature ulcer causes hemorrhage from the left gastric A.

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13
Q

There are three different types of vagotomies. Truncal is when nerve supply to all of stomach/GI/liver is lost. What occurs in selecetive gastric and selective proximal vagotomy?

A

selective gastric: denervates branches of vagas nerve only to stomach
Selective proximal: denervates in areas of stomach where the parietal cells are.

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14
Q

Why would someone need a gastric vagotomy?

A

It is the surgical treatment for GERD

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15
Q

The duodenum begins at the pylorus and ends at the duodenojejunal junction. The first (superior) part (at L1) is sometimes divided into two. why is this? What is the ligament that attaches here?

A

Because one part is intraperitoneal and the other is retroperitoneal.

The hepatoduodenal ligament (lesser omentum) attaches here

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16
Q

The second (descending) part at L2/3 is important because it contains the minor and major duodenal papilla and hepatopancreatic ampulla. What is released through these?

A

Bile from the gallbladder and pancreas via the bile duct and pancreatic duct

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17
Q

What would occur to vomit if there is an obstruction before the descending (2nd) part of the duodenum? (this is before the papilla)

A

there will be no bile in the vomit!

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18
Q

The 3rd segement or horizontal duodenum is crossed over by a vein and artery. What are they? What passes behind the 3rd segment?

A

Superior mesenteric vein and artery. Which can compress the duodenum. The IVC and aorta pass behind it

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19
Q

The 4th segement or ascending is up due to the suspensory muscle. What flexure or junction occurs here?

A

Duodenojejunal flexure/junction occurs here and connects to the jejunum

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20
Q

The suspensory muscle of the duodenum has another name, what is it? What does it separate?

A

ligament of Treitz, which separates upper and lower GI which can help you tell where the bleeding is coming from

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21
Q

The jejunum is located in the left upper quadrant and is intraperitoneal. The ileum is in the RLQ. How are they attached to the posterior wall?

A

Via a mesentary which is a double layer of peritoneum that houses A/V/lymph/fat/N

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22
Q

How can one determine the difference between the jejunum and ileum from the vasa recta, arcades, and circular folds (plicae circulares)?

A

The vasa recta are long, with large arcade loops and the plicae circulares are more abundant and larger in the jejunum.
Ileum has short vasa recta, small loops, low/absent plicae circulares

23
Q

What pathology is seen in 2% of the population, 2 times more likely in males, and most common in the first 2 years of life. Usually asymptomatic, has a persistent vitelline/omphalomesenteric duct that can contain ectopic gastric or pancreatic tissue

A

Meckel Diverticulum

24
Q

What occurs mostly in children, commonly at the ileocecal junction and is when proximal bowel segement is inside distal segement?

A

Intussusception… can cause bleeding at the ileocecal jxn

25
Q

The ileocecal jxn is at L5, transtubercular plane. Where can the lower edge of the cecum be found?

A

S2- interspinous plane

26
Q

The colon is made up of the cecum, appendix, ascending, trasnverse, descending and sigmoid colon and begins at the ileocecal junction. What are the two important external features?

A

The 3 tenia coli (muscle with fat called appendices epiploicae) and haustra

27
Q

What is the area that is tender to palpation when considering appendicitis and where can this area be found?

A

1/3 of the way between right ASIS and umbilicus in RLQ, called McBurney’s point

28
Q

The cecum is intraperitoneal and contains ileal pailla. Ileocecal valve regulates passage of contents from?

A

ileal to cecum

29
Q

The ascending colon is continuous with the transverse colon at the?

A

right colic (hepatic) flexure

retroperitoneal

30
Q

The transverse colon is suspended by the transverse mesocolon and is continuous with the descedning colon at the?

A

left colic (splenic) flexure

31
Q

The descending colon is retroperitoneal and has a left paracolic gutter, continuous with?

A

sigmoid colon

32
Q

The sigmoid colon is at S3, and is suspended by a long mesentary called the sigmoid mesocolon. Teniae coli terminate at the rectosigmoid junction. What is most commonly seen here in the elderly?

A

Volvulus

33
Q

What are teniae coli?

A

Smooth longitudinal muscles of the coloN

34
Q

What occurs when a loop of bowel rotates on itself at the sigmoid colon, resulting in constipation, ischemia and necrosis?

A

Volvulus in elderly

occurs commonly in the midgut in infants 2/3rd transverse colon

35
Q

In front of the spleen is the fundus of the stomach, posterior is the left kidney and left suprarenal gland and inferiorly is? (2)

A

tail of pancreas and left colic flexure

36
Q

The liver is the largest abdominal organ in the RUQ. The top of the liver is at the xiphisternal plane and follows the subcostal line. How would one take a biopsy?

A

Find the 10th rib, have patient exhale and hold to avoid collapsed lung

37
Q

What are the left and right anatomic lobes separated by?

A

falciform ligament, which connects to the anterior abdominal wall

38
Q

There are two additional lobes of the right, know as the quadrate lobe (left hemi-liver) and the ?

A

caudate lobe which functionally is separate (considered “third liver”

39
Q

The round ligament of the liver is remnant of the umbilical vein while the ligamentum venosum is remnant of?

A

ductus venosus, which allowed blood to bypass the fetal liver

40
Q

What ligament contains the proper hepatic artery, bile duct, and the portal vein?

A

hepatoduodenal ligament which is the anterior boundary of the epiploic foramen

41
Q

What is the imaginary line from the fundus of the gallbladder superiorly to the diaphragm?

A

Cantlie line, which is doen the middle of the right lobe

42
Q

What are the lobe segments in the left lateral division of the function liver?

A

II and III

43
Q

What are the lobe segments in the left medial division?

A

IV and I on the back

*Note I is the caudate lobe which receives blood supply from both portal bundles

44
Q

What are the lobe segements in the right medial division?

A

VIII and V

45
Q

What are the lobe segements in the right lateral division?

A

VII and VI

46
Q

The gallbladder is a blind diverticulum attached to a common bild duct via cystic duct, which is between what segments of the liver?

A

IV and V

47
Q

The common bile duct meets with the pancreatic duct to empty into the ampulla of vater in the 2nd part of the duodenum, which is also known as?

A

hepatopancreatic ampulla

48
Q

Gallstones can have different effects depending on where they are located. What are the organs involved if they are in each of the following three places?
Before the cystic duct
In the common bile duct
In the ampulla of vater

A
  1. Cholecystitis, only the gallbladder is affected
  2. Liver/gallbladder affected
  3. Pancreas, Liver and gallbladder all involved
49
Q

Cholelithiasis is a stone in the gallbladder, which can cause cholecytitis, typically in forty+ females who have had kids. What sign/ maneuver can be used to determine this?

A

Muprhy’s sign: Palpate RUQ and ask pt to inhale, if pain or halt in inspiration = cholecytitis

50
Q

Choledocolithiasis is caused by an obstruction of the common bile duct while _______- is the obstruction of the ileocecal junction from a gallstone.

A

gallstone ileus: gallstone migrates from gallbladder to duodenum, and travels and gets stuck in ileocecal jxn

51
Q

The spleen is the largest lympathic organ located in the LUQ. What two ligaments are associated with the spleen?

A

splenorenal ligament (splenic artery) and the gastrosplenic ligament (short gastric arteries)

52
Q

The stomach is anterior to the spleen, the diaphragm and the 9th-11th ribs are posterior. What is inferior and medial?

A

inferior is the left colic flexure of the colon and medial is the left kidney

53
Q

What do we call the ridged outpouchings of colon traveling along the tinea coli?

A

Haustra

54
Q

What do we call the small outpouchings of fat protruding from the tinea coli?

A

Omental appendicies

11. GastroIntestinal Exam 1 (10 decks)

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