Cards For Week Of Oct 1 Flashcards
Where does hind but start and stop?
Distal transverse colon to rectum
What are derivates of midgut? (Between what segments)?
Duodenum to transverse colon
Cause of sternal defects in development of anterior abdomen?
Defect in rostral fold closure
Anterior abdominal wall failure of closure caudally can cause?
bladder extrophy
omphalocele result froms failure of closure of?
What other defect can result from same site?
Lateral folds of anterior abdominal wall
Gastroschisis- intestine sticks out through abdominal wall, not covered by peritonemum
what is omphalocele?
persistence of herniation of abdominal content into umbilical cord, covered by peritoneum
What genetic cause assocaited w/ duodenal atresia?
Trisomy 21
what is duodenal atresia?
congenital absence or complete closure of a portion of the lumen of the duodenum. It causes increased levels of amniotic fluid during pregnancy (polyhydramnios) and intestinal obstruction in newborn babies. Radiography shows a distended stomach and distended duodenum, which are separated by the pyloric valve, a finding described as the “double-bubble sign.”
In abdomen, vascular accidents (apple peel atresia) can cause atresia in what segments of GI?
Jejunal
Ileal
Colonic
Describe midgut development (with wk #)
6th wk: midgut herniates through umbilical ring
10th wk: returns to abdominal cavity & rotates around SMA
In development, midgut rotates around what BV?
SMA (10th week, as midgut goes back in abdominal cavity)
MC type of esophageal atresia w/ Sx?
TEF- tracheoesophageal fistula (EA + fistula)
Sx: Drooling, choking, vomiting w/ 1st feed.
Allows air to enter stomach (seen on CXR)
Cyanosis w/ larygospasm
How to test for Tracheaoesophageal fistula?
failure to pass NG tube into stomach
Which condition shows a gasless abdomen on CXR?
Pure esophageal atresia or stenosis
Describe H-type, Pure TEF
Fistula alone
Sx of congenital pyloric stenosis
projectile vomiting @ 2 wks old
palpabile olive mass in epigastric region
more in firstborn males
Pancrease as a whole derived from?
foregut
What gives rise from ventral pancreatic bud?
Pancreatic head
Main pancreatic duct
Uncinate process
Where does uncinate process come from? (embro origin)
ventral bud only
What becomes of the dorsal pancreatic duct?
Body
Tail
Isthmus
Accessory Pancreatic duct
What disease caused by ventral pancreatic bud abnormally rotating around duodenum causing narrowing; constrictor?
Annular pancreas
What is pancreas divisum
ventral and dorsal parts fail to fuse @ week 8
Where does spleen come from?
Mesentary of stomach (mesodermal)
What is blood supply of spleen?
Celiac artery (foregut)
What are the retroperitoneal strucutre?
SAD PUCKER
Suprarenal (adrenal) gland Aorta & IVC Duodenum (2nd & 3rd part) Pancreas (excapt tail) Ureters Colon (asc & desc) Kidneys Esophagus (low 2/3) Rectum
What is the portal triad made of?
Portal vein
Proper hepatic artery
Common bile duct
What is w/n the hepatoduodenal ligament?
portal triad
What does the falciform ligament connect? What does it contain?
connects liver to anterior abdomen
has ligamentum teres hepatis
What in embryonic origin of ligamentum teres hepatis?
Fetal umbilical vein
What is pringle maneuver?
Hepatoduodenal lig. compressed between thumb & index finger w/n emental foramen (Foramen of Winslow)
used to control bleeding!
What connects the greater and lesser sac?
Foramen of Winslow/ Omental foramen
What ligaments are gastric arteries found?
Gastrohepatic ligament
What does gastrohepatic lig. connect?
liver to lesser curvature of stomach
what seperates greater and lesser sac on right?
gastrohepatic ligament
What is w/n gastrocolic ligament? what does it connect?
gastroepiploic arteries
connects greater curvature of stomach to transverse colon
What seperates greaters and lesser sacs on left?
on right?
Left: Gastrosplenic ligament
Right: Gastrohepatic ligament
what is w/n gastrosplenic ligament?
connects?
short gastrics & left gastroepiploic vessels w/n
connects greater curvature & spleen
what is w/n splenorenal ligament?
Splenic artery & vein
tail of pancreas
What connects spleen to posterior abdominal wall?
splenorenal ligament
What is the lesser omentum?
lesser omentum (small omentum; gastrohepatic omentum) is the double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the start of the duodenum.
What is the lesser sac?
The lesser sac, also known as the omental bursa, is the cavity in the abdomen that is formed by the lesser and greater omentum.
What are the layers of the gut wall?
Inside to outside Mucosa Submucosa Muscualris externa Serosa
“MSMS”
What is Basal electric rhythm?
determines the frequency of the contractions in the gastrointestinal (GI) tract
Smooth muscle contraction by ENS, or Ca influx (by receptor activation)
What are B.E.R. values (normal) for:
Stomach
Duodenum
Ileum
Stomach- 3 waves/min
Duodenum- 12 waves/min
Ileum: 8-9 waves/min
What layer (s) of GI gut wall erosion occur?
only mucosa
What layer(s) can ulcers be found?
Mucosa, submucosa, and/or to inner or outer muscle layer
compare serosa to adventia
In the abdomen, whether an organ is covered in adventitia or serosa depends upon whether it is peritoneal or retroperitoneal:
- intraperitoneal organs are covered in serosa (a layer of mesothelium, the visceral peritoneum)
- retroperitoneal organs are covered in adventitia (loose connective tissue)
What is w/n muscularis externa layers? Fx?
Myenteric nerve plexus (aka Auerbach’s)- controls inner circular & outer longitudinal muscle contractions
What layer is Meissner’s plexus found? Fx?
Submucosa- control of secretory activity
What muscle layer w/n Mucosa?
Fx?
Muscualris mucosae
Fx- motility
describe colon histo
crypts
NO villi
many goblet celsl
Where is the largest # of goblet cells in small intestine?
Ileum
Describe histo of ileum
Peyer’s patches
Plicae circulares (proximal ileum)
Crypts pf Lieberkuhn
Many goblet celsl
histo of Jejunum?
Plicae circualres
crypts of Lieberkuhn
Describe histo of duodenum?
Villi & microvilli
Brunners glands
crypts of Lieberkuhn
histo of esophagus
nonkeratinized stratified squamous
What are crypts of Lieberkühn?
gland found in the epithelial lining of the small intestine and colon. The crypts and intestinal villi are covered by epithelium which contains two types of cells, goblet cells (secreting mucus) and enterocytes (absorbing water and electrolytes).
What is SMA syndrome?
3rd segment of duodenum, transverse, entrapped bwn SMA & ascending aorta
At what level does andominal aorta bifurcarte?
L4
What are the levels of Celiac artery?
SMA?
IMA?
Celiac artery @ T12/L1
SMA- L1
IMA- L3
PANS innervation of Celiac, SMA, IMA?
Vagus supplies Celiac & SMA
Pelvic nerve supplies IMA
What does the SMA give blood for?
MidgutDistal duodenum to proximal 2/3 of transverse cp;pm
What does IMA supply?
The hindgut: distal transverse colon to upper portion of rectum
What is watershed region?
referring to regions of the body that receive dual blood supply from the most distal branches of two large arteries, such as the splenic flexure of the large intestine are particularly susceptible to ischemia.[1] The blood supply from the two vessels does not overlap.
What are risks for watershed region in hypotension? in Ischemia?
During times of blockage of one of the arteries that supply the watershed area, such as in atherosclerosis, these regions are spared from ischemia by virtue of their dual supply. However, during times of systemic hypoperfusion, such as in disseminated intravascular coagulation or heart failure, these regions are particularly vulnerable to ischemia by virtue of the fact that they are supplied by the most distal branches of their arteries, and thus the least likely to receive sufficient blood.
What is blood supply of splenic flexure?
SMA & IMA
it is a watershed region
How are sigmoid colon and rectum watershed regions?
blood supply from inferior mesenteric, pudendal and iliac circulations
What is suplied by celiac artery?
Foregut!
Stomach to proximal duodenum Liver GB Pancrease Spleen (mesoderm)
What causes jaundice, with elevated in UCB only?
-Extravascular hemolysis
-ineffective eryhtropoiesis
- UGT low:
mild low: Gilbert syndrome
severe; absent: Crigler-Najjar
What are abnormal levels of unconjugated bilirubin in urine?
Trick question!
UCB is non water soluble, so, should NOT be present at all in urine
What are the branches of the abdoinal aorta?
“Prostitutes Cause Super Super Red Testicles Lubaring Into My Cock” pg. 312
What are the branches of Left gastric artery?
pg. 313
What are branches of Common Hepatic arter?
pg/ 313
What are branches of Splenic artery?
Pancreatic branches
Left gastroepiploic
Short gastric
Which splenic artery branch has poor anastomoses?
short gastric
What are collateral circulation of GI?
Super epigastric –> ?
inferior epigastric (external ilaic)
What is collateral circulation of ? superior pancreaticoduodenal (celiac trunk)-->
inferior pancreaticoduodenal (SMA)
What is collateral circulation of ? middle colic (SMA)--->
left colic (IMA)
Collateral circulation of Superior rectal (IMA)?
middle & inferior rectal
internal iliac
What is “coalminer’s lung” called? Which part of lung is affected?
Anthrcosis
Upper lobes
When do you see eggshell calcification of the hilar lymph nodes?
Silicosis
What are the types of restrictive lung diseases?
Poor breathing mechanics (extra pulmonary, peripheral hypoventilation, normal A-a gradient)
- Poor muscular effort like Polio, MG
- interstitial lung diseases
