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Anatomy GI > Clinical correlations > Flashcards

Clinical correlations Flashcards

1
Q

What is colonic diverticulosis?

A
  • Condition when multiple false diverticula develop along the large intestine
  • what happens is that there is mucosal herniations that protrude through weak areas of the muscular wall
  • it is normal in the elderly and can be a problem
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2
Q

Where is colonic diverticulosis most commonly found and who does it affect usually?

A
  • mesenteric side of two bands of Taenia coli (momental and free) due to the perforating nutrient arteries
  • also found not eh sigmoid colon
  • usually effects middle aged people and beyond
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3
Q

What are risk factors for colonic diverticulosis ?

A
  • low fibre (high meat) and BMI over 25
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4
Q

What is the systemic venous system?

A

Veins that drain deoxygenated blood directly to the heart

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5
Q

What is the hepatic portal venous system?

A

-Veins that drain nutrient rich deoxygenated blood from the intestines and the spleen to the liver

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6
Q

What is cirrhosis of the liver?

A
  • progressive destruction of hepatocytes (functional cell in the liver)
  • these liver cells are replaced by fibrous tissue and regenerative nodules (lumps) which causes the liver to become firm and circulation becomes inhibited
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7
Q

What is the cause and treatment of cirrhosis?

A
  • cause: chronic alcoholism, hepatitis B and C, fatty liver disease
  • treatment: shunt of venous blood from the portal system to the caval (systemic) system or if very bad then liver transplant
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8
Q

What is portal hypertension?

A
  • increase in pressure of the blood travelling in the veins of the portal system.
  • obstruction in the route to the liver will cause reverse collateral flow from portal system veins. The small caliber veins are not suitable to handle reversed blood flow for a long period of time .

-causes several other conditions

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9
Q

Causes of portal hypertension?

A
  1. ) supra hepatic causes:
    - cardiac diseases
    - hepatic vein thrombosis
  2. ) Hepatic causes:
    - cirrhosis and acute liver failure
    - hepatocellular cancer
    - schistosomiasis
  3. ) infra hepatic causes:
    - arteriovenous malformation
    - tumor in the head of the pancreas
    - splenomegaly
    - portal vein thrombosis
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10
Q

What is portacaval anastomoses?

A

The hepatic portal vein and its branches don’t have valves therefore if venous drainage of the GI tract gets blocked at the hepatic portal veins then blood can bypass the liver by flowing in the reverse direction (collateral flow) and drain to the inferior vena cava through an alternative route.

Alternative route:

  • left gastric goes to esophageal
  • paraumbilical goes to epigastric
  • colic and splenic goes to retroperitoneal
  • superior rectal goes to middle/inferior rectal

These portacaval anastomoses become important when the drainage route to the liver becomes blocked

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11
Q

What are esophageal varices?

A

It is when the esophageal veins become enlarged as a result of portal hypertension.

Essentially there are two anastomoses:

  1. ) Portal system - left and right gastric veins
  2. ) Caval system - Esophageal veins

When there is retroflow because of blockage to the liver, there will be drainage to the esophageal veins which will dilate them and since they are fragile they might get damaged and excessive bleeding occurs. this can be fatal.

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12
Q

How can esophageal varices be treated and what are its symptoms ?

A

Treatment - endoscope to directly inject the varices with clotting medicine or a band to cut off circulation

symptoms - black stool, paleness, vomiting (emesis - blood vomiting), symptoms of chronic liver disease

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13
Q

What is Caput medusa?

A

there is an anastomosis between:

  1. ) portal system - paraumbilical veins
  2. ) caval system - epigastric veins

In cases where blood cant travel to the liver and there is backflow to the paraumbilical veins.

This will cause the superficial veins of the anterior abdominal wall (superficial epigastric and thoracoepigastric) to become extremely dilated and varicose which will make it look there are snakes under the skin.

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14
Q

What is the treatment for caput medusa?

A

-reduce portal hypertension by diverting the portal blood by creating a shunt or communication between larger veins of the caval system to relieve pressure. Hepatic portal vein to the IVC or the splenic vein to the left renal vein.

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15
Q

What are hemorroids?

A

Anastomosis between:

  1. ) portal system - superior rectal veins
  2. ) caval system - inferior rectal veins

because of increased pressure in the lower rectal area causing these veins to expand sort of.

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16
Q

What is an internal hemorrhoid?

A
  • above the pectinate line
  • not painful because of visceral inenrvation
  • if damaged then you will get bright red blood in the stool because it is close to the source and blood hasnt been digested (lower GI tract bleed)
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17
Q

What is an external hemorrhoid?

A
  • below the pectinate line
  • very painful because of somatic innervation
  • develop from varicose perianal veins that are part of the caval system
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18
Q

What is the anastomosis between the foregut and the midgut?

A

superior pancreaticoduodenal

inferior pancreaticoduodenal

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19
Q

What is the anastomosis between the midgut and the hindgut?

A

middle colic

left colic

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20
Q

What is peritonitis?

A

Infection can occur if gas, fecal matter or bacteria enter the peritoneal cavity which would result in inflammation of the peritoneum. This will result sin inflammation of the peritoneum.

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21
Q

What is the difference betweent inflammation of teh parietal and visceral peritoneum?

A

parietal - sharp, well localised pain and tenderness on palpation

visceral - generalised referred pain that is felt in the associated dermatome of the organ

22
Q

What is exudate?

A

a fluid rich in cellular elements, serum, fibrin, acid or pus that has seeped out and been discharged from an inflamed organ or vessel.

23
Q

What is ascitic fluid?

A

Excess fluid in the peritoneal cavity called ascites

24
Q

What is paracentesis?

A

Surgical pumcture of the peritoneal cavity for the aspiration/drainage of ascitic fluid.

25
Q

What is an appendectomy?

A

The surgical removal of the appendix by:

  1. ) trough a transverse or grid iron incision centered at mcburneys point. Nerves most at risk are illiohypogastric and ilioinguinal.
  2. ) through laproscopic surgery
26
Q

Initial appendicitis vss acute appendicitis?

A

intitial - general visceral afferent pain fibers are reffered to T10 dermatome

acute - general somatic afferent pain fibers are localised at mcburneys point

27
Q

How can a splenic rupture happen?

A

Although the spleen protected by the rib cage, if there is a traummatic blow to the left side, this may fracture the ribs which will leave fragemetns on teh spleen which whill cause laceration of the spleen. this may lead to shock and intraperitoneal hemorrhage and profuse internal bleeding.

Can occurin like a car accident being hit by the steering wheel in the left side.

28
Q

What is a splenectomy ?

A

surgical removal of the spleen to prevent bleeding to death

29
Q

What is splenomegaly?

A

Pathological enlargement of the spleen (upto 10X thenormal size) and this is accompanied by high blood pressure.

30
Q

What is cholelithiasis?

A
  • gallstones
  • small lumps of solid stone like deposits which form in the gallbladder
  • They form when there are high concentrations of cholestrol and can be asssociated with individuals who are regularly dehydrated
  • common in females and relatively asymptomatic
31
Q

Symptoms of cholelithiasis ?

A
  • pain in right upper quadrant
  • pain may be referred to the right neck or shoulder region
  • nausea
  • inflammation of the gallbladder (cholecystitis)
  • Jaundice due to obstruction of major papilla or common bile duct
32
Q

What is a common constriction site where cholelithiasis becomes painfully lodged?

A

The hepatopancreatic ampulla.

33
Q

What is a cholecystectomy?

A

Surgical procedure to remove the gallbladder. Gallbladder not a vital organ so some people may elect to remove it if there is a reoccurance of gallstones and it causes severe biliary colic.

34
Q

Why is it important to identify the cystohepatic triangle in a cholecystectomy?

A

To determine if there is variation of the cystic artery or biliary apparatus. Once they are identified they are ligated and divided to prevent bleeding and release of bile.

35
Q

What are the boundries of the cystohepatic triangle?

A

superior border - inferior border of the liver

medial border - common hepatic duct

lateral border - cystic duct

36
Q

What are the kindss of pancreatic cancer and what can they do?

A

Cancer of the head of the pancreas:

  • most common kind
  • could obstruct common bile duct, hepatopancratic ampulla
  • retention of bile pigments will lead to jaundice which can lead to stools becoming acholic (light grey)

Cancer of the neck and body of the pancreas:

  • tumor can obstruct the hepatic portal vein
  • tumor can obstruct the IVC
37
Q

What is jaundice and what is it caused by?

A

The yellowing of the skin and sclera of teh eyes which usualyl results if bile cant be released into the duodenum

38
Q

What is pyrosis and what causes it?

A
  • heartburn
  • most common form of esophageal discomfort and substernal pain
  • there is a burining sensation in the abdominal part of the esophagus which is percieved in the chest
  • typically a reuslt of regurgitation of gastric acid into the abdominal part of the esophagus
  • Gastroesophageal reflux disorder
39
Q

What is the function of the inferior esophageal sphincter?

A

To prevent acid reflux

40
Q

What are peptic ulcers?

A
  • a distinct lesion or necrosis of the muscosa in either the stomach, pyloric canal, or duodenum as a result of acid erosion.
41
Q

What are gastric ulcers and gastritis?

A
  • 2 most common stomach diseases in which men are three times more likely to get affected
  • associated with mucosal exposure to gastric acid and pepsin, helicobacter pylori bacterial infections, nonsteroidal anti inflammatory drugs, and aspirin.
42
Q

Waht are some symptoms of peptic ulcers?

A
  • hematesmesis - vomiting “coffee ground blood”
  • Melena - black foul smelling feces
43
Q

Carcinoma of the stomach?

A

-Majority of the gastric cancers are adenocarcinomas which originate in the glandular tissue

44
Q

Why is surgery hard for carcinoma?

A

Becuase it is difficult due to the inability to remove all of the lymphatic nodes associated with the stomach

45
Q

What can transillumination help with in regards to carcinoma of the stomach?

A

-help identify small tumors although if virchow’s lymph nodes are palpable (left supraclavicular) then malignancy is advanced and the prognosis is poor.

46
Q

Types of surgery for carcinoma of the stomach?

A
  1. ) endoscopic resection
  2. ) partial gastrectomy
  3. ) total gastrectomy
47
Q

What is troisier’s sign?

A

Hard, palpable enlarged left supraclavicular lymph nodes indicate metastatic cancer in the abdomen.

48
Q

What is crohn’s disease ?

A
  • colitis
  • chronic inflammation of the gastrointestinal tract
  • most commonly affects the ileum and the beginnign of teh large intestine.
  • Although it can poccur anywhere from the mouth to the anus
49
Q

What is the treatment of crohn’s disease?

A
  • treatment is designed to supress the inflammation of the GI tract
  • however in 70 % of cases you have to be mroe invasive:
    1. ) colectomy: terminal ileum, colon, and rectum are removed
    2. ) ileostomy: artificial opening of the healthy ileum is created through the abdominal wall
    3. ) colostomy: opening is created to drain stool
50
Q

Referred pain of the abdominal organs? (stomach, small intestine, appendix, acending colon, transverse colon, proximal descending colon, distal descending colon, rectum)

A

Stomach - T6 - T9

Small intestines - T8-T10

Appendix - T10

Ascending and transverse colon - T10-T11

Proximal descending colon - T12-L1

Distal descending colon - L2-L3

Rectum - S2-S4

Anatomy GI (8 decks)

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