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LCK STEP > CHAPTER: GI (Embryo, Anatomy, Phys) > Flashcards

CHAPTER: GI (Embryo, Anatomy, Phys) Flashcards

1
Q

Structures in the hepatoduodenal lig

A 
Portal triad 
1. Hepatic art (going)
2. Portal vein (going)
3. Common bile duct (coming)
Pringle = clamp all 3 to buy time to find liver bleeder
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2
Q

Structures contain in the gastrocolic // splenorenal ligaments

A

Gastrocolic = greater curve stomach to transverse colon
Contains L + R gastro-epiploic arteries
Spleno-renal ligament connects spleen to post ab wall
1. Splenic A + V
2. Tail of pancreas (aka what isn’t retro)

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3
Q

What are 2 ways you can get into the lesser sac?

A

Lesser sac (post) and the greater sac (ant) are created by the ligaments
On L: gastrosplenic
On R: gastrohepatic
1. Cut through the gastrohepatic to get in
2. Foramen of Winslow = natural opening between liver, hepatoduo lig, and duodenum

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4
Q

Name the 4 layers of the gut wall in order and the structures within them

A 
MSMS
Mucosa 1. epi 2. LP (CT) 3. muscularis mucosa 
*Erosions only through mucosa*
Submucosa w/ Meissners to secrete fluids
*Ulcers extend into subM*
Muscularis externa - inner circ, Myenteric for motility, outer long
4th: 
1. Intraperitoneal organs = serosa
2. Retro = adventitia
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5
Q

Fastest section of the GI tract

A

Duodenum > ileum > stomach

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6
Q

Histo for duodenum + what absorbed here

A

IRON
Villi + MV
Brunner - make bicarb
Crypts of L = regen

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7
Q

Histo jejunum + what absorbed here

A

FAT + FOLATE
Plicae circulares ↑↑SA
Lacteals
Crypts of L

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8
Q

Histo ileum + what absorbed here

A

B12, IF, BILE ACIDS
Peyers patches
↑est # goblet cells
Crypts L, plicae

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9
Q

Difference in histo between stomach and colon

A

Both simple columnar
Stomach: gastric pits (acid) + glands (mucous)
Colon: crypts of goblet cells only

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10
Q

Only BV off aorta that runs in front of the IVC

A

Gonadal

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11
Q

What are connects the sup + inf mesenteric arteries

A

Marginal artery
@ L flexure
If you have to ligate IMA, this is how the colon with get colateral from SMA

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12
Q

What condition would cause the SMA to compress the duodenum between it and the aorta causing post prandial pain?

A

Malnutrition -> lose fat around the SMA

Duodenum between SMA (top) and aorta (bottom)

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13
Q

BS, sympa, and para to foregut, midgut, and hindgut

A

Fore: celiac
Mid: SMA
Both sympa = greater + lesser splanchnic n; para = vagus
Hind: IMA. lumbar splanchnic, pelvic n (para)

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14
Q

Trace the common hepatic artery’s branches as it comes out of SMA

A

Proper hepatic
1. Into liver via hepato-duo lig (portal triad)
2. R gastric art (lesser curve)
Gastroduo art
1. R gastroepip (greater curve, L coming from splenic)
2. Ant pancreaticoduodenal
3. Post-sup pancreaticoduodenal

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15
Q

What are the 3 veins that varices are trying to get access to for shunting

A

GOAL = direct drain into IVC
Esophagus - back up into L gastric so get into azygos
Caput medusae - open paraumbilical veins into small epigastric veins
Anorectal varices - back up into sup rectal to get into middle inf rectal

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16
Q

A/LN/V and cancer above the pectinate line

A

A: sup rectal (IMA)
V: sup rectal -> IMV -> portal
LN: int iliac
Adenocarcinoma (GI tract)

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17
Q

A/N/V/LN and cancer below the pectinate line

A

A: inf rectal (int pudendal) - ↓BS post causes anal fissure
V: inf rectal -> internal iliac -> IVC (↑bioavail for drugs)
LN: superficial inguinal
N: pudendal nerve = somatic innervation = painful hemroid
SCC (HPV)

18
Q

What do Ito cells? What organ?

A

Liver
Store vit A
Produce ECM

19
Q

Which zone liver affected by metabolic toxins

A

3

This is where p450 is - activates the drugs therefore ↑est risk damage

20
Q

Zone for alcoholic vs viral hepatitis

A

1 - viral

3 - alcoholic (p450)

21
Q

Zone for yellow fever

A 
2
Yellow fever = flavi (+ssRNA) 
Back pain
Jaundice
Bloody stool 
Aedes mosquito, live atten vaccine
22
Q

Role of Kupffer

A

Liver macrophages

Breakdown RBCs to make BR

23
Q

Structures in the femoral triangle vs sheath

A

NAVL
Triangle = N, A, V
Sheath = A, V, deep inguinal LN in femoral canal
Go medial for central venous access

24
Q

What is the double duct sign

A

Stone obstructs ampulla vater

See the main and accessory pancreatic ducts dialted

25
Q

3 parts Hesselbach triangle

A

Rectus ab
Inf epigastric vessels
Inguinal ligament
Why direct hernias are medial to inf epi vessels (vs indirect lateral)

26
Q

What hernia gives you
Hourglass stomach
Fundus stomach into thorax
Entire stomach into thorax

A

Sliding hiatal
Paraesophageal
Hiatal

27
Q

Where are K cells - what do they excrete?

A

D +J
GIP = incretin
↑insulin release
↓gastric acid (stop digesting, we’ve got it down here)
INCRETIN EFFECT is why you get so much more insulin with PO > IV glucose loads

28
Q

Symptoms of a VIPoma

A

VIP stim parasympa (M3) @ sphincters, GB, SI - rest, digest (also how macrolides stim GI motility)
Watery diarrhea
HypoK
Achlorhydria

29
Q

Fxn secretin

A

↑bicarb from pancreas to make SI more basic for enzymes to work

30
Q

Where does CCK vs secretin work in the pancreas?

A

CCK @ acinar cells - ↑secretions

Secretin @ ductal cells - ↑bicarb

31
Q

Enzyme for protein digestion

A

Pepsin from chief cells in stomach

Acid in stomach activates - therefore protein digestion starts in stomach

32
Q

2 ways vagus ↑acid secretion

A

ACh @ parietal cells
GRP = gastrin releasing peptide @ G cells (duo) -> gastrin into circulation to bind parietal and #1 ECL cells (release H)

33
Q

3 phases of acid secretion

A
  1. Cephalic = small, thought, taste - vagus
  2. Gastric = stomach distension - gastrin
  3. Intestinal ↓acid via YY peptide from ECL cells
34
Q

SI BB enzymes that activate trypsin

A

Enterokinase

Enteropeptidase

35
Q

What 2 AAs do bile acids get conj to making them H2O sol?

A

Glycine or taurine

36
Q

What enzyme is the rate lim step of bile acid synthesis

A

Cholesterol 7alpha hydrox

37
Q

2 SI receptors that absorb monosacc

A

SGLT1 - glucose + galactose
Na co-trans (use the Na gradient)
GLUT 5 - facilitated diffusion fructose

38
Q

Enzyme that converts UCBR into CBR in the liver to make H2O sol

A

UDP glucuronosyl transferase
Gut bacteria convert CBR -> urobili
Stercobilin - feces
Urobilin - urine

39
Q

Which fold failures cause omphalocele + gastroschisis vs bladder exstrophy

A

O/G - lateral fold closure defect

Bladder out - caudal fold closure defect

40
Q

Cause jejunal and ileal atresia

A

Disrupt mesenteric vessels -> ischemic necrosis
Triple bubble or apple peel
Vs duodenal atresia = fail recanalize
Double bubble

41
Q

Exposure to macrolide ↑risk what

A

Hypertrophic pyloric stenosis
1st born males too
Olive mass 2-6 wks after bith
PROJECTILE vomiting

42
Q

Fore vs mid vs hind gut derivatives

A

Fore - mouth -> duodenum (celiac art)
Mid - duodenum -> prox 2/3 transverse (SMA)
Herniates through umbilical ring to grow
Hind - to above the pectinate (IMA)

LCK STEP (27 decks)

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