CHAPTER: GI (Embryo, Anatomy, Phys) Flashcards
Structures in the hepatoduodenal lig
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
Structures contain in the gastrocolic // splenorenal ligaments
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)
What are 2 ways you can get into the lesser sac?
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
Name the 4 layers of the gut wall in order and the structures within them
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
Fastest section of the GI tract
Duodenum > ileum > stomach
Histo for duodenum + what absorbed here
IRON
Villi + MV
Brunner - make bicarb
Crypts of L = regen
Histo jejunum + what absorbed here
FAT + FOLATE
Plicae circulares ↑↑SA
Lacteals
Crypts of L
Histo ileum + what absorbed here
B12, IF, BILE ACIDS
Peyers patches
↑est # goblet cells
Crypts L, plicae
Difference in histo between stomach and colon
Both simple columnar
Stomach: gastric pits (acid) + glands (mucous)
Colon: crypts of goblet cells only
Only BV off aorta that runs in front of the IVC
Gonadal
What are connects the sup + inf mesenteric arteries
Marginal artery
@ L flexure
If you have to ligate IMA, this is how the colon with get colateral from SMA
What condition would cause the SMA to compress the duodenum between it and the aorta causing post prandial pain?
Malnutrition -> lose fat around the SMA
Duodenum between SMA (top) and aorta (bottom)
BS, sympa, and para to foregut, midgut, and hindgut
Fore: celiac
Mid: SMA
Both sympa = greater + lesser splanchnic n; para = vagus
Hind: IMA. lumbar splanchnic, pelvic n (para)
Trace the common hepatic artery’s branches as it comes out of SMA
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
What are the 3 veins that varices are trying to get access to for shunting
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
A/LN/V and cancer above the pectinate line
A: sup rectal (IMA)
V: sup rectal -> IMV -> portal
LN: int iliac
Adenocarcinoma (GI tract)
A/N/V/LN and cancer below the pectinate line
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)
What do Ito cells? What organ?
Liver
Store vit A
Produce ECM
Which zone liver affected by metabolic toxins
3
This is where p450 is - activates the drugs therefore ↑est risk damage
Zone for alcoholic vs viral hepatitis
1 - viral
3 - alcoholic (p450)
Zone for yellow fever
2 Yellow fever = flavi (+ssRNA) Back pain Jaundice Bloody stool Aedes mosquito, live atten vaccine
Role of Kupffer
Liver macrophages
Breakdown RBCs to make BR
Structures in the femoral triangle vs sheath
NAVL
Triangle = N, A, V
Sheath = A, V, deep inguinal LN in femoral canal
Go medial for central venous access
What is the double duct sign
Stone obstructs ampulla vater
See the main and accessory pancreatic ducts dialted
