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Wrongs > 5/24 GI > Flashcards

5/24 GI Flashcards

1
Q

midgut development

A

6th week midgut herniates through umbilical ring

10th- returns to abdominal vacity and roates around SMA 270 degrees clockwise

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2
Q

duodenal atresia

A

failure to recanalize–> dilate stomach and prox duodenum

down’s- double bubble

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3
Q

jejunal and ileal atresia

A

disrupt mesenteric vessels–> ischemic necrosis–> segmental resorption

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4
Q

retroperitoneal structures

A

Suprarenal (adrenal) glands
Aorta, IVC
Dudenum (2nd-4th)

Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus (thoracic)
Rectum
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5
Q

falciform ligament

A

liver to anterior abdominal wall

ligamentum teres

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6
Q

hepatoduodenal ligament

A

liver to duodenum

contains portal triad

pringle manuever- control bleeding

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7
Q

gastrohepatic ligament

A

liver to lesser curve of stomach

carries gastric arteries

separates greater and lesser sacs on the right

cut during surgery to access lesser sac

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8
Q

Gastrocolic ligament

A

greater curvature and transverse colon

carries gastroepiploic arteries

part of greater omentum

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9
Q

gastrosplenic ligament

A

greater curvature and spleen

carries short gastrics, left gastroepiploic vessels

separates greater and lesser sacs on the left

part of greater omentum

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10
Q

splenorenal ligament

A

spleen to posterior abdominal wall

carries splenic artery and vein, tail of pancreas

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11
Q

ulcers vs erosions

A

erosions- only mucosa

ulcers- all the way through submucosa and muscularis layer

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12
Q

abdominal aorta branches in order

A 
T12- celiac trunk, middle suprarenal
L1- SMA, 
L1-L2- renal, gonadal
L3-IMA
L4- bifurcation into iliacs
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13
Q

what does celiac trunk supply?

A

foregut!

pharynx, lower esophagus to proximal duodenum

mesoderm- liver, gallbladder, pancreas, spleen

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14
Q

what does SMA supply

A

midgut! distal duodenum to proximal 2/3 of transverse colon

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15
Q

what does IMA supply

A

hindgut! distal 1/3 of transverse colon to upper rectum

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16
Q

3 main branches of celiac trunk

A

common hepatic
splenic
left gastric

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17
Q

which arteries anastomose in esophageal varices?

A

left gastric– azygos

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18
Q

which arteries anastomose in caput medusae?

A

paraumbilical– small epigastric veins of anterior abdominal wall

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19
Q

which arteries anastomose in anorectal varices

A

superior rectal— middle and inferior rectal

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20
Q

what is the treatment for portal hypertension

A

TIPS- transjugular portosystemic shunt- shunts blood to systemic circulation bypassing the liver

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21
Q

pectinate line

A

where hindgut of endoderm meets ectoderm

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22
Q

arteries, veins, lymphatics of above pectinate line in rectum

A

superior rectal artery

superior rectal vein –> IMV –> portal

lymph- internal iliac nodes

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23
Q

arteries, veins, lymphatics of below pectinate line in rectum

A

inferior rectal artery (pudendal branch)

inferior rectal vein –> internal iliac vein –> common iliac vein –> IVC

lymph- superior inguinal nodes

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24
Q

hepatic space of disse

A

store vitamin A

produce ECM

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25
Q

zone 1 of liver most affected by

A

viral hepatitis

ingested toxins

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26
Q

zone 2 of liver most affected by

A

yellow fever

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27
Q

zone 3 most affected by

A

(centrilobular)

  • ischemia
  • cyt p450–> metabolic toxins
  • alcoholic hepatitis
28
Q

3 layers of spermatic cord

A

ICE

Internal spermatic fascia (transversalis fascia)
Cremasteric muscle and fascia (internal oblique)
External spermatic fascia (external oblique)

29
Q

diaphragmatic hernia

A

causes: trauma; congential defect in pleuroperitoneal membrane

mostly on left side (no liver protection)

  • -sliding hiatal hernia (GEJ displaced)
  • -paraesophageal hernia (fundus protrudes)
30
Q

which layer of spermatic cord is direct hernia covered by

A

external spermatic fascia (whereas indirect hernia has all 3 layers)

31
Q

what are the 3 sides of hesselbach triangle

A

inferior epigastric arteries
lateral border of rectus abdominis
inguinal ligament

(where direct hernias are)

32
Q

where is CCK made

A

I cells of duodenum and jejunum

33
Q

where is secretin made and function

A

S cells of duodenum

increases pancreatic bicarb and bile secretion
decreases gastric acid

34
Q

glucose-dep insulinotropic peptide source and function

A

K cells (duodenum, jejunum)

decreases gastric acid secretion
increases insulin release (why oral glucose leads to more insulin release than IV)

35
Q

motilin souce and function

A

small intestine

produce migrating motor complexes during fasting state

36
Q

vasoactive intestinal peptide source and function

A

parasympathetic ganglia in sphincters, gall bladder, and small intestine (vagal stim.)

increases intestinal water and electrolyte secretion
relaxes intestinal smooth muscle and sphincters

37
Q

VIPoma

A

islet pancreatic tumor- secretes VIP

watery diarrhea
hypokalemia
achlorhydria

38
Q

pancreatic secretions types

A

alpha amylase
lipases
proteases
trypsinogen

39
Q

what is high in low flow in pancreatic secretions and what is high in high flow

A

low flow –> high Cl

high flow –> high HCO3

40
Q

apthous ulcer

A

painful superficial ulcer due to stress

gray base surrounded by erythema

41
Q

behcet syndrome

A

recurrent apthous ulcers, genital ulcers, uveitis

due to immune complex vasculitis of small vessels

42
Q

sialadenitis

A

inflammation of salivary gland

stone obstruction –> staph aureus

43
Q

pleomorphic adenoma

A

benign mixed tumor (most in parotid)

chondromyxoid stroma (cartilage) and epithelium (glands)

recurs if not excised completely (irregular border)

44
Q

warthin tumor

A

papillary cystadenoma lymphomastum-

benign, cystic with germinal centers

parotid gland mostly

45
Q

mucoepidermoid carcinoma

A

malignant salivary tumor (parotid)

mucinous and squamous

facial nerve - pain or paralysis

46
Q

lymph node spread in upper 1/3 of esophagus

A

cervical nodes

47
Q

lymph node spread in middle 1/3 of esophagus

A

mediastinal

tracheobronchial

48
Q

lymph node spread in lower 1/3 of esophagus

A

celiac and gastric nodes

49
Q

complications of ulcer

A

—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

50
Q

vit E deficiency symptoms

A

ataxia
impaired prioception and vibratory sense
hemolytic anemia

look out for some form of malabsorption in anecdote

51
Q

Abetapoproteinemia

A

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

52
Q

acute hep A on histo

A

hepatocyte ballooning degeneration and apoptosis with mononuclear cell infiltrate

53
Q

how do people with crohn’s get gallstones

A

ileum inflamm–> cant absorb bile acids –> higher cholesterol: bile acids –> gallstones

54
Q

riboflavin deficiency

A

(seen in alcoholics)

precursor for FAD, FMN –> TCA (succinate dehydrogenase ) and ETC

symptoms: angular stomatitis, chelitis, glossitis, eye changes, anemia, seborrheic dermatitis

55
Q

surgical landmark for appendectomy

A

taenia coli- to its origin at cecal base

56
Q

how do you test for malabsorptive disorders

A

fat malabsorption most sensitive (since fats earliest affected usually)

Sudan III stain

57
Q

diagnosis and treatment of hirschsprung disease

A

diagnose: rectal suction biopsy- see no ganglion cells in submucosa
treatment: resection

58
Q

angiodysplasia

A

tortuous dilatation of blood vessels–> hematochezia

in cecum, right colon

elderly

59
Q

ileus

A

intestinal hypomotility without obstruction

associations: surgery, opiates, hypokalemia, sepsis

60
Q

meconium ileus

A

in CF: meconium plug obstructs intestine –> blocks stool from passing

61
Q

cancers associated with lynch syndrome

A

colorectal
ovarian
endometrial
skin

62
Q

lab finding in HCC

A

increased AFP

63
Q

mallory bodies

A

seen in alcoholic hepatitis

esoinophilic inclusions of damaged keratin filaments

64
Q

somatostatin functions

A

decrease gastric acid and pepsinogen
decrease pancreatic and small intestine fluid secretion
decrease gall bladder contraction
decrease insulin and glucagon release

65
Q

diseases that are p-ANCA besides vasculitis

A

ulcerative colitis

primary sclerosing cholangitis

66
Q

c dif toxins

A

inactivate Rho regulatory proteins in actin cytoskeleton structure maintenance –> disrupt tight junctions –> fluid secretion

67
Q

how does lactose intolerance lead to acidic stool

A

fermenting undigested lactose by gut bacteria –> short chain fatty acids –> acidify stool –> hydrogen produced

Wrongs (36 decks)

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