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FA: GI > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What specifically are the retroperitoneal structures?

A 
Suprarenal (adrenal) gland
Aorta and IVC
Duodenum (2nd and 3rd parts)
Pancreas (except tail)
Ureters
Colon (descending and ascending
Kidneys
Esophagus (lower 2/3)
Rectum (lower 2/3)
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2
Q

Injuries to retroperitoneal structures cause what?

A

blood or gas accumulation in retroperitoneal space

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3
Q

Direct injury to the kidney has caused a laceration to it. Where will the blood drain?

A

retroperitoneum

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4
Q

generally, what are included as retroperitoneal structures?

A

GI structures lacking a mesentery and non-GI structures

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5
Q

What is found in the ligament that connects liver to anterior abdominal wall? what is it a derivative of?

A

Falciform ligament contains ligamentum teres hepatis;

Falciform ligament is derivative of ventral mesentery

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6
Q

What is contained in the ligament that connects liver to duodenum? what what else does it connect?

A

Hepatoduodenal ligament contains portal triad

Hepatoduodenal ligament connects greater and lesser sacs

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7
Q

What is found in the portal triad?

A

hepatic artery,
portal vein,
common bile duct

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8
Q

How will a surgeon control bleeding from the structures w/in the hepatoduodenal ligament?

A

Pringle maneuver=> ligament compressed bw thumb and index finger placed in omental foramen to control bleeding

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9
Q

what is contained in the ligament connecting the liver to the lesser curvature of the stomach?

A

gastrohepatic ligament contains the gastric arteries

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10
Q

What does the gastrohepatic ligament separate? when might it be cut?

A

separates greater and lesser sacs ON RIGHT;

cut during surgery to access lesser sac

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11
Q

What does ligament connecting the greater curvature of the stomach to the transverse colon contain?

A

gastrocolic ligament contains gastroepiploic arteries

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12
Q

What is gastrocolic ligament apart of?

A

greater omentum

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13
Q

What ligament does the greater curvature of stomach and spleen contain?

A

gastrosplenic ligament contains short gastrics, left gastroepiploic vessels

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14
Q

What does gastrosplenic ligament separate?

A

separates greater and lesser sacs on LEFT

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15
Q

What does the ligament connecting the spleen to posterior abdominal wall contain?

A

splenorenal ligament contains splenic artery and vein along w/ tail of pancreas

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16
Q

What are the layers of the gut wall from inside to outside?

A 
MSMS;
Mucosa
Submucosa
Muscularis externa
Serosa
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17
Q

What is found in the mucosa in the gut wall? give function for each

A

epithelium => absorption;
lamina propria => support;
muscularis mucosa => motility

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18
Q

What is found in the submucosa of the gut wall?

A

submucosal nerve plexus (meissner’s plexus)

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19
Q

What is found in the muscularis externa of the gut wall?

A

myenteric nerve plexus (Auerbach’s plexus)

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20
Q

What part of the gut wall is variable depending on location w/in the body?

A

serosa => intraperitoneal

adventitia => retroperitoneal

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21
Q

Differentiate ulcers from erosions

A

ulcers extend into submucosa, inner or outer muscular layer;

Erosions are in mucosa only

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22
Q

What are the frequencies of basal electric rhythm throughout the GI tract?

A

Stomach: 3 waves/min

duodenum: 12 waves/min
ileum: 8-9 waves/min

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23
Q

What type of cells characterize normal esophagus?

A

nonkeratinized stratified squamous epithelium

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24
Q

what cells, structures characterize stomach?

A

gastric glands

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25
Q

what cells, structures characterize duodenum?

A

villi and microvilli increases absorptive surface;
Brunner’s glands (submucosa);
crypts of Liekberkuhn

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26
Q

what cells, structures characterize jejunum?

A

Plicae circulares;

crypts of Lieberkuhn

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27
Q

what cells, structures characterize ileum?

A

Peyer’s patches (lamina propria, submucosa);
plicae circulares (proximal ileum);
cyrpts of Lieberkuhn

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28
Q

Where are the largest number of goblet cells in small intestine?

A

ileum

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29
Q

what cells, structures characterize colon?

A

crypts but no villi, numerous goblet cells

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30
Q

differentiate artery supplying GI vs non-GI structures

A

supplying GI branch ANTERIORLY

non-GI branch LATERALLY

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31
Q

Describe SMA syndrome

A

transverse portion (3rd segment) of duodenum entrapped bw SMA and aorta => intestinal obstruction

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32
Q

where does the celiac trunk branch?

A

branches anteriorly from T12

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33
Q

What branches from L1?

A

SMA and left renal artery

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34
Q

What branches from L3?

A

IMA

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35
Q

where does bifurcation of abdominal aorta occur?

A

L4

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36
Q

What artery branches inferior portion of abdominal aorta?

A

median sacral artery

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37
Q

Which testicular artery branches first from the aorta?

A

left testicular (ovarian) artery just above right testicular (ovarian) artery

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38
Q

what is the artery, parasympathetic innervation and vertebral level of the foregut region?

A

celiac
vagus
T12/L1

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39
Q

What are the structures supplied by the foregut artery?

A

stomach to proximal duodenum;

liver, gallbladder, pancreas, spleen (mesoderm)

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40
Q

What is the artery, parasympathetic innervations and vertebral level of midgut region?

A

SMA
Vagus
L1

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41
Q

What are the structures supplied by the midgut artery?

A

Distal duodenum to proximal 2/3 transverse colon

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42
Q

what is the artery, parasympathetic innervation and vertebral level of the hindgut region?

A

IMA
Pelvic
L3

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43
Q

What are the structures supplied by the hindgut artery?

A

Distal 1/3 transverse colon to upper portion of rectum;

44
Q

What part of the GI is most susceptible to ischemia?

A

splenic flexure of the colon due to SMA and IMA anastomoses => if ischemia occurs then distal region of artery is most susceptible to damage

45
Q

What are the branches of celiac trunk?

A

common hepatic artery;
splenic artery;
left gastric artery

46
Q

what does the celiac trunk supply mostly?

A

main supply of the stomach

47
Q

If the splenic artery, what is the most likely site for ischemia other than the spleen?

A

fundus of stomach due to poor anastomases of the short gastrics

48
Q

Where do strong anastomoses of the celiac trunk occur?

A

Left and right gastroepiploics;

Left and right gastrics

49
Q

what arteries would be subject to damage with a posterior duodenal artery?

A

gastroduodenal artery giving rise anterior superior pancreaticoduodenal arteries and right gastroepiploic artery

50
Q

generally, what will compensate if branches of abdominal aorta are blocked?

A

collateral circulation w/ arterial anastomoses

51
Q

Specifically, what will compensate if superior epigastric of internal thoracic/mammary artery is blocked?

A

inferior epigastric artery (external iliac)

52
Q

Specifically, what will compensate if superior pancreaticoduodenal artery of celiac trunk is blocked?

A

inferior pancreaticoduodenal artery (SMA)

53
Q

Specifically, what will compensate if middle colic of SMA is blocked?

A

left colic of IMA

54
Q

Specifically, what will compensate if superior rectal of IMA is blocked?

A

middle and inferior rectal arteries of internal iliac

55
Q

what are the sites of portosystemic anastomoses?

A

Esophagus;
umbilicus;
Rectum

56
Q

What are the portal and systemic anastomoses at the esophagus?

A

left gastric (portal) esophageal (systemic)

57
Q

What are the portal and systemic anastomoses at the umbilicus

A

paraumbilical (portal) superficial & inferior epigastric below umbilicus (systemic)

paraumbilical (portal) superior epigastric and lateral thoracic above umbilicus

58
Q

What are the portal and systemic anastomoses at the rectum?

A

superior rectal (portal) middle & inferior rectal (systemic)

59
Q

What is the clinical sign of portal hypertension seen at the esophagus?

A

esophageal varices

60
Q

What is the clinical sign of portal hypertension seen at the umbilicus?

A

caput medusae

61
Q

What is the clinical sign of portal hypertension seen at the rectum?

A

internal hemorrhoids

62
Q

Where are the varices commonly seen w/ portal HTN?

A

gut, butt, caput (medusae)

63
Q

How is portal HTN Tx surgically?

A

TIPS (transjugular intrahepatic portosystemic shunt) between portal vein and hepatic vein percutaneously relieves portal HTN by shunting blood to systemic circulation

64
Q

Where is the pectinate (dentate line)?

A

formed where endoderm (hindgut) meets ectoderm

65
Q

What are common pathologies that occur above the pectinate line?

A

internal hemorrhoids;

adenocarcinoma

66
Q

Arterial supply above pectinate line?

A

superior rectal artery (branch of IMA)

67
Q

What is the venous drainage above pectinate line?

A

superior rectal vein => inferior mesenteric vein => portal system

68
Q

Differentiate internal vs external hemorrhoids

A

IH: visceral innervation so NOT PAINFUL; lymph drainage to DEEP NODES

EH: somatic innervation (inferior rectal branch of pudendal nerve) so PAINFUL; lymph drainage to SUPERFICIAL INGUINAL NODES

69
Q

pathologies below the pectinate line?

A

external hemorrhoids, squamous cell carcinoma

70
Q

Arterial supply below pectinate line?

A

inferior rectal artery (branch of internal pudendal artery)

71
Q

venous drainage below pectinate line?

A

inferior rectal vein => internal pudendal vein => internal iliac vein => IVC

72
Q

What do the different surfaces of the hepatocytes face?

A

apical surface faces bile canaliculi;

basolateral surface faces sinusoids

73
Q

What are the 3 zones of the liver?

A

Zone I: periportal zone;
Zone II: intermediate zone
Zone III: pericentral zone (centrilobular)

74
Q

What zone is affected 1st by viral hepatitis?

A

Zone I

75
Q

What is found in the zone III of the liver?

A

affected 1st by ischemia;
contains p-450 system;
most sensitive to TOXIC INJURY;
Site of ALCOHOLIC HEPATITIS

76
Q

What is the direction of blood and bile flow in the liver respective to the zones of the liver?

A

blood flow from zone I to zone III;

bile flow from zone III to zone I

77
Q

Describe the path of the common bile duct to its release of bile in the duodenum

A

Common hepatic duct joins w/ cystic duct => common bile duct => sphincter of Oddi => ampulla of vater

78
Q

Where would gallstones block both bile and pancreatic ducts?

A

ampulla of Vater

79
Q

Pancreatic tumor in the head of the pancreas may cause what?

A

obstruction of common bile duct

80
Q

What is the organization of the femoral region?

A 
Lateral to medial:
Nerve
Artery
Vein
Empty
Lymphatics
81
Q

What is found in the femoral triangle?

A

femoral vein, artery, nerve (venous near penis)

82
Q

Define the femoral sheath

A

fascial tube 3-4cm below inguinal ligament

83
Q

What is found in the femoral sheath?

A

femoral vein, artery, canal (deep inguinal lymph nodes) but not femoral nerve

84
Q

What is the site of protrusion of indirect hernias?

A

internal inguinal ring

85
Q

site of protrusion of direct hernia?

A

abdominal wall

86
Q

What tissue makes up the external spermatic fascia?

A

external oblique

87
Q

What tissue makes up cremasteric muscle and fascia?

A

internal oblique

88
Q

What tissue makes up internal spermatic fascia?

A

transversalis fascia

89
Q

Define hernia

A

protrusion of peritoneum through an opening, usually a site of weakness

90
Q

When might a diaphragmatic hernia develop in an infant?

A

result of defective development of pleuroperitoneal membrane

91
Q

describe the most common diaphragmatic hernia

A

hiatal hernia => stomach herniates upward through esophageal hiatus of diaphragm

92
Q

Describe the most common hiatal hernia

A

sliding hiatal hernia => GEJ displaced upward and “HOURGLASS STOMACH”

93
Q

What is a hiatal hernia where the GEJ is normal?

A

paraesophageal hernia => fundus protrudes into thorax

94
Q

What is a protrusion of peritoneum going through internal (deep) inguinal ring, external (superficial) inguinal ring, and into scrotum?

A

indirect inguinal hernia

95
Q

In an indirect inguinal hernia, where does the protrusion enter internal inguinal ring?

A

lateral to inferior epigastric artery

96
Q

Who is at higher risk to develop indirect inguinal hernia?

A

males especially infants

97
Q

An indirect inguinal hernia in an infant is most likely due to what?

A

failure of processus vaginalis to close (can form hydrocele)

98
Q

An indirect inguinal hernia follows what path? what covers it?

A

path of descent of testes => covered by all 3 layers of spermatic fascia

99
Q

Where does a direct inguinal hernia protrude?

A

inguinal (Hesselbach’s) triangle and bulges directly through abdominal wall medial to inferior epigastric artery

100
Q

What differentiates indirect from direct hernias regarding inferior epigastric artery?

A

MD’s don’t LIe
Medial to inferior epigastric artery = Direct hernia

Lateral to inferior epigastric artery = Indirect hernia

101
Q

What covers the direct hernia?

A

external spermatic fascia

102
Q

Who is most commonly to have a direct inguinal hernia?

A

older men

103
Q

Define a femoral hernia

A

protrusion of peritoneum below inguinal ligament through femoral canal below and lateral to pubic tubercle

104
Q

Who is femoral hernia most likely found in?

A

women

105
Q

Femoral hernia will likely cause what in the bowel?

A

bowel incarceration

106
Q

Give the borders of Hesselbach’s triangle

A

lateral: inferior epigastric vessels
Medial: lateral border of rectus abdominis
Inferior: inguinal ligament

FA: GI (7 decks)

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