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USMLE GI > Anatomy > Flashcards

Anatomy Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the retroperitoneal structures?

A

SAD PUCKER

  • Suprarenal (adrenal) adrenal
  • Aorta and IVC
  • Duodenum (2nd - 4th part)
  • Pancreas (except tail)
  • Ureters
  • Colon (descending and ascending)
  • Kidneys
  • Esophagus (thoracic portion)
  • Rectum (partially)
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2
Q

What does the falciform ligament connect?

A

Liver to anterior abdominal wall

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3
Q

What does the hepatoduodenal ligament connect?

A

Liver to duodenum

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4
Q

What does the hepatogastric ligament connect?

A

Liver to the lesser curvature of the stomach

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5
Q

What does the gastrocolic ligament connect?

A

Greater curvature and transverse colon

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6
Q

What does the gastrosplenic ligament connect?

A

Greater curvature to the spleen

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7
Q

What does the splenorenal ligament connect?

A

Spleen to left pararenal space

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8
Q

What ligaments are derived of the ventral mesentery?

A
  • Falciform ligament
  • Hepatoduodenal ligament
  • Hepatogastric ligament
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9
Q

What ligaments are derived from the dorsal mesentery?

A
  • Gastrocolic ligament
  • Gastrosplenic ligament
  • Splenorenal ligament
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10
Q

What structures are contained in the falciform ligament?

A
  • Ligamentum teres hepatis (derivative of fetal umbilical vein)
  • Patent paraumbilical veins
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11
Q

What is contained in the hepatoduodenal ligament?

A

Portal triad

  • Proper hepatic artery
  • Portal vein
  • Common bile duct
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12
Q

What ligaments are contained in the lesser omentum?

A
  • Hepatoduodenal ligament

- Hepatogastric ligament

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13
Q

What ligaments are contained in the greater omentum?

A
  • Gastrocolic ligament

- Gastrosplenic ligament

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14
Q

What does the omental foramen connect?

A

The greater and lesser sacs

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15
Q

What ligament is held in Pringle maneuver?

A

Hepatoduodenal ligament (contains portal triad)

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16
Q

What are the borders of the omental foramen?

A
  • Anterior: Hepatoduodenal ligament
  • Posterior: the peritoneum covering the inferior vena cava
  • Superior: the peritoneum covering the caudate lobe of the liver
  • Inferior: the peritoneum covering the commencement of the duodenum and the hepatic artery, the latter passing forward below the foramen before ascending between the two layers of the lesser omentum.
  • Left lateral: gastrosplenic ligament and splenorenal ligament
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17
Q

Name the layers of the gut wall from inside to out?

A
  • Mucosa (epithelium, lamina propria, muscularis mucosa)
  • Submucosa (Meissner’s plexus)
  • Muscularis externa (Auerbach’s/myenteric plexus) (contains inner/circular and outer/longitudinal layer)
  • Serosa
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18
Q

What part of the GI tract has the fatest and slowest basal electric rhythms?

A

Duodenum (fastest) > Ileum > Stomach (slowest)

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19
Q

What cells produce slow waves?

A

Interstitial cells of Cajal

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20
Q

When does an erosion become an ulcer?

A

Once it extends into the submucosal layer

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21
Q

What part of the esophagus is striated muscle and what is smooth?

A
  • Upper 1/3 is striated

- Lower 2/3 is smooth

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22
Q

Describe the cells of the esophagus

A

Nonkeratinised stratified squamous epithelium

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23
Q

Histology of GI tract

A

First aid page 372

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24
Q

How many arteries supply the adrenal glands?

A

3

  • Superior suprarenal (T12)
  • Middle suprarenal (T12)
  • Inferior suprarenal (L1)
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25
Q

What areas of the colon are ‘watershed’ areas?

A
  • Splenic flexure (SMA and IMA)

- Rectosigmoid junction (last sigmoid arterial branch from IMA and superior rectal artery)

26
Q

What is Nutcracker syndrome?

A

The compression of the left renal vein between the SMA and Aorta.

  • Adbominal pain
  • Gross hematuria (from rupture of thin-walled renal varicosities)
  • Left-sided varocele
27
Q

What is superior mesenteric artery syndrome?

A

Aorta and SMA compress transverse (3rd) portion of duodenum

  • Intermittent intestinal obstruction symptoms
  • Postprandial pain
  • Associated with low body weight/malnutrition (low mesenteric fat)
28
Q

At what vertebral level do the celiac trunk, SMA and IMA branch off?

A
  • Celiac - T12/L1
  • SMA - L1
  • IMA - L3
29
Q

What are the branches of the Celiac trunk?

A
  • Left gastric (esophageal branches from this)
  • Splenic (gives off short gastric and left gastroepiploic)
  • Common hepatic
30
Q

What are the branches of the common hepatic artery?

A

Proper hepatic

  • R hepatic
  • Left hepatic
  • Cystic

Right gastric

Gastroduodenal

  • Ant Sup pancreaticoduodenal
  • Post Sup pancreaticoduodenal
  • Right gastroepiploic
31
Q

What veins are joined in caput medusae?

A
  • Paraumbilical (portal)

- Small epigastric (systemic)

32
Q

What can be used to treat portal hypertension?

A
  • Transjugular Intrahepatic Portosystemic Shunt (TIPS)

- May cause build up of ammonia -> encephalopathy

33
Q

What veins come together to form anorectal varices?

A
  • Superior rectal vein (portal)

- Middle and inferior rectal veins (systemic)

34
Q

What cancers do you get above the pectinate line?

A

Adenocarcinoma

35
Q

What type of hemorrhoids are painful and why?

A

External hemorrhoids (if thrombosed) as they receive somatic innervation from the inferior rectal branch of the pudendal nerve

36
Q

What cancers do you get below the pectinate line?

A

Squamous cell carcinoma

37
Q

Where does the inferior rectal artery arise from?

A

Internal pudendal artery

38
Q

Where are anal fissures loacted?

A 
Posterior midline (poorly perfused) 
- Below pectinate line
39
Q

Where does the lymph above the pectinate line drain to?

A

Internal iliac lymph node

40
Q

Where does the lymph below the pectinate line drain to?

A

Superficial inguinal lymph node

41
Q

What is the functional unit of the liver (the lobule) made up of?

A
  • Hexagonal
  • Each corner contains a portal triad
  • In the centre is a central vein (which drains into the hepatic vein)
  • Sinusoids ( which carry fluid from th portal triad to the central vein
42
Q

What is the function of Kupffer cells?

A
  • Specialised macrophages
  • Clear bacteria
  • Clear damaged or senescent RBCs
43
Q

What cells are responsible for hepatic fibrosis?

A
  • Hepatic stellate (Ito) cells in the space of Disse
44
Q

What do hepatic stellate cells store?

A

Vitamin A

45
Q

What zone is affected by yellow fever?

A

Zone II (intermediate zone)

46
Q

What effects Zone I (periportal zone) ?

A
  • Viral hepatitis

- Ingested toxins (cocaine)

47
Q

What affects zone III (pericentral/centrilobular) zone?

A
  • Ischaemia

- Ethanol, CCl4, halothane, rifampin, acetaminophen)

48
Q

Where is the enzyme cytochrome P-450 mostly found?

A

Zone III

49
Q

Cancer of the head of the pancreas has what sign?

A

Courvoisier sign (painless jaundice and enlarged gallbladder)

50
Q

What are the bordes of the femoral triangle?

A
  • Superiorly (base): Inguinal ligament
  • Lateral: Sartorius major
  • Medial: Adductor longus
51
Q

What does the femoral sheath contain?

A

Femoral artery, vein and lymph (does not contain femoral nerve, this lies laterally)

52
Q

What is contained in the femoral canal (ring)?

A

deep inguinal lymph nodes

53
Q

What are the differences between indirect and direct inguinal hernias in terms of there relation to epigastric vessels?

A
  • Indirect inguinal hernias occur lateral to inferior epigastric vessels
  • Direct inguinal hernias occur medialy to inferior epigastric vessels
54
Q

What type of hernia only passes through the superficial inguinal ring (and thru Hesselbach’s triangle)?

A

Direct inguinal hernia

- Indirect hernias pass through both deep and superficial inguina rings

55
Q

How many layers of spermatic fascia are covered by an indirect inguinal hernia?

A
  • All 3
56
Q

What are the 3 layers of spermatic fascia?

A

Internal spermatic fascia
- from transversalis fascia

Cremasteric muscle and fasica
- from internal oblique

External spermatic fascia
- External oblique

57
Q

Anatomy of groin

A

Page 379

58
Q

In a paraesophageal hiatal hernia what protrudes through to the thorax?

A

The fundus

- The gastroesophageal junction is usually intact

59
Q

What is an indirect inguinal hernia caused by?

A

A failure of the tunica vaginalis to close (may form a hydrocele)

60
Q

What type of hernia is more common in females and more likely to cause strangulation?

A

Femoral hernia

61
Q

Where is a femoral hernia located?

A
  • Below and lateral to pubic tubercle

- Through femoral canal

62
Q

What is Zollinger-Ellison syndrome caused bY?

A

Gastrinoma

  • G cells produce too much gastrin
  • Resulting in too much H+ secretion

USMLE GI (4 decks)

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