5/24 GI Flashcards
midgut development
6th week midgut herniates through umbilical ring
10th- returns to abdominal vacity and roates around SMA 270 degrees clockwise
duodenal atresia
failure to recanalize–> dilate stomach and prox duodenum
down’s- double bubble
jejunal and ileal atresia
disrupt mesenteric vessels–> ischemic necrosis–> segmental resorption
retroperitoneal structures
Suprarenal (adrenal) glands
Aorta, IVC
Dudenum (2nd-4th)
Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys Esophagus (thoracic) Rectum
falciform ligament
liver to anterior abdominal wall
ligamentum teres
hepatoduodenal ligament
liver to duodenum
contains portal triad
pringle manuever- control bleeding
gastrohepatic ligament
liver to lesser curve of stomach
carries gastric arteries
separates greater and lesser sacs on the right
cut during surgery to access lesser sac
Gastrocolic ligament
greater curvature and transverse colon
carries gastroepiploic arteries
part of greater omentum
gastrosplenic ligament
greater curvature and spleen
carries short gastrics, left gastroepiploic vessels
separates greater and lesser sacs on the left
part of greater omentum
splenorenal ligament
spleen to posterior abdominal wall
carries splenic artery and vein, tail of pancreas
ulcers vs erosions
erosions- only mucosa
ulcers- all the way through submucosa and muscularis layer
abdominal aorta branches in order
T12- celiac trunk, middle suprarenal L1- SMA, L1-L2- renal, gonadal L3-IMA L4- bifurcation into iliacs
what does celiac trunk supply?
foregut!
pharynx, lower esophagus to proximal duodenum
mesoderm- liver, gallbladder, pancreas, spleen
what does SMA supply
midgut! distal duodenum to proximal 2/3 of transverse colon
what does IMA supply
hindgut! distal 1/3 of transverse colon to upper rectum
3 main branches of celiac trunk
common hepatic
splenic
left gastric
which arteries anastomose in esophageal varices?
left gastric– azygos
which arteries anastomose in caput medusae?
paraumbilical– small epigastric veins of anterior abdominal wall
which arteries anastomose in anorectal varices
superior rectal— middle and inferior rectal
what is the treatment for portal hypertension
TIPS- transjugular portosystemic shunt- shunts blood to systemic circulation bypassing the liver
pectinate line
where hindgut of endoderm meets ectoderm
arteries, veins, lymphatics of above pectinate line in rectum
superior rectal artery
superior rectal vein –> IMV –> portal
lymph- internal iliac nodes
arteries, veins, lymphatics of below pectinate line in rectum
inferior rectal artery (pudendal branch)
inferior rectal vein –> internal iliac vein –> common iliac vein –> IVC
lymph- superior inguinal nodes
hepatic space of disse
store vitamin A
produce ECM
zone 1 of liver most affected by
viral hepatitis
ingested toxins
zone 2 of liver most affected by
yellow fever
zone 3 most affected by
(centrilobular)
- ischemia
- cyt p450–> metabolic toxins
- alcoholic hepatitis
3 layers of spermatic cord
ICE
Internal spermatic fascia (transversalis fascia)
Cremasteric muscle and fascia (internal oblique)
External spermatic fascia (external oblique)
diaphragmatic hernia
causes: trauma; congential defect in pleuroperitoneal membrane
mostly on left side (no liver protection)
- -sliding hiatal hernia (GEJ displaced)
- -paraesophageal hernia (fundus protrudes)
which layer of spermatic cord is direct hernia covered by
external spermatic fascia (whereas indirect hernia has all 3 layers)
what are the 3 sides of hesselbach triangle
inferior epigastric arteries
lateral border of rectus abdominis
inguinal ligament
(where direct hernias are)
where is CCK made
I cells of duodenum and jejunum
where is secretin made and function
S cells of duodenum
increases pancreatic bicarb and bile secretion
decreases gastric acid
glucose-dep insulinotropic peptide source and function
K cells (duodenum, jejunum)
decreases gastric acid secretion
increases insulin release (why oral glucose leads to more insulin release than IV)
motilin souce and function
small intestine
produce migrating motor complexes during fasting state
vasoactive intestinal peptide source and function
parasympathetic ganglia in sphincters, gall bladder, and small intestine (vagal stim.)
increases intestinal water and electrolyte secretion
relaxes intestinal smooth muscle and sphincters
VIPoma
islet pancreatic tumor- secretes VIP
watery diarrhea
hypokalemia
achlorhydria
pancreatic secretions types
alpha amylase
lipases
proteases
trypsinogen
what is high in low flow in pancreatic secretions and what is high in high flow
low flow –> high Cl
high flow –> high HCO3
apthous ulcer
painful superficial ulcer due to stress
gray base surrounded by erythema
behcet syndrome
recurrent apthous ulcers, genital ulcers, uveitis
due to immune complex vasculitis of small vessels
sialadenitis
inflammation of salivary gland
stone obstruction –> staph aureus
pleomorphic adenoma
benign mixed tumor (most in parotid)
chondromyxoid stroma (cartilage) and epithelium (glands)
recurs if not excised completely (irregular border)
warthin tumor
papillary cystadenoma lymphomastum-
benign, cystic with germinal centers
parotid gland mostly
mucoepidermoid carcinoma
malignant salivary tumor (parotid)
mucinous and squamous
facial nerve - pain or paralysis
lymph node spread in upper 1/3 of esophagus
cervical nodes
lymph node spread in middle 1/3 of esophagus
mediastinal
tracheobronchial
lymph node spread in lower 1/3 of esophagus
celiac and gastric nodes
complications of ulcer
—hemorrhage:
if gastric–> lesser curvature–> left gastric artery
if duodenal–> posterior–> gastroduodenal artery
—obstruction
—perforation:
anterior duodenum
free air under diaphragm- referred pain to shoulder
vit E deficiency symptoms
ataxia
impaired prioception and vibratory sense
hemolytic anemia
look out for some form of malabsorption in anecdote
Abetapoproteinemia
MTP mutation –> defect in apoliprotein B (absent chylmicrons, VLDL)
–> lipids cant be absorbed –> accumulate in intestinal epithelium –> enterocytes with clear/foamy cytoplasm
–> malabsorption of fat-sol vitamins, neuro problems, acanthocytes
acute hep A on histo
hepatocyte ballooning degeneration and apoptosis with mononuclear cell infiltrate
how do people with crohn’s get gallstones
ileum inflamm–> cant absorb bile acids –> higher cholesterol: bile acids –> gallstones
riboflavin deficiency
(seen in alcoholics)
precursor for FAD, FMN –> TCA (succinate dehydrogenase ) and ETC
symptoms: angular stomatitis, chelitis, glossitis, eye changes, anemia, seborrheic dermatitis
surgical landmark for appendectomy
taenia coli- to its origin at cecal base
how do you test for malabsorptive disorders
fat malabsorption most sensitive (since fats earliest affected usually)
Sudan III stain
diagnosis and treatment of hirschsprung disease
diagnose: rectal suction biopsy- see no ganglion cells in submucosa
treatment: resection
angiodysplasia
tortuous dilatation of blood vessels–> hematochezia
in cecum, right colon
elderly
ileus
intestinal hypomotility without obstruction
associations: surgery, opiates, hypokalemia, sepsis
meconium ileus
in CF: meconium plug obstructs intestine –> blocks stool from passing
cancers associated with lynch syndrome
colorectal
ovarian
endometrial
skin
lab finding in HCC
increased AFP
mallory bodies
seen in alcoholic hepatitis
esoinophilic inclusions of damaged keratin filaments
somatostatin functions
decrease gastric acid and pepsinogen
decrease pancreatic and small intestine fluid secretion
decrease gall bladder contraction
decrease insulin and glucagon release
diseases that are p-ANCA besides vasculitis
ulcerative colitis
primary sclerosing cholangitis
c dif toxins
inactivate Rho regulatory proteins in actin cytoskeleton structure maintenance –> disrupt tight junctions –> fluid secretion
how does lactose intolerance lead to acidic stool
fermenting undigested lactose by gut bacteria –> short chain fatty acids –> acidify stool –> hydrogen produced
