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Year 2 Gastrointestinal > Clinically applied GI I > Flashcards

Clinically applied GI I Flashcards

1
Q

from esophagus to rectum the GI tube is composed of how many layers?

A

4

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2
Q

what type of epithelium makes up the esophagus?

A

stratified squamous keratinized

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3
Q

the epithelium lies on top of what layer?

A

basal lamina

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4
Q

the basal lamina lies on what layer?

A

lamina propria

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5
Q

what are the four layers of the GI tract?

A
  1. mucosa
  2. submucosa
  3. muscularis externa
  4. serosa
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6
Q

what is the histological makeup of the mucosal epithelium?

A

proximal and distal - stratified squamous nonkeratinized

rest of the tract is simplu columnar

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7
Q

in which sections of the GI tract are there glands in the submucosa?

A

esophagus and duodenum

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8
Q

what layers make up the mucosa?

A

epithelium, lamina propria, muscularis mucosae

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9
Q

what are the enteric nerve plexuses?

A

submucosal (meissner’s) and myenteric (auerbach’s)

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10
Q

the submucosal (meissner’s) plexus carries what fibers?

A

parasympathetic postganglionic and sympathetic postglanglionic fibers

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11
Q

what is the function of the submucosal (meissner’s) plexus?

A

regulates activity of muscularis mucosae, gland secretion, blood flow

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12
Q

the myenteric (auerbach’s) plexus carries what fibers?

A

parasympathetic postganglionic neurons and sympathetic postganglionic fibers

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13
Q

what is the function of the myenteric (auerbach’s) plexus?

A

regulates activity of muscularis externa

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14
Q

what is the z line?

A

region in esophagus where stratified squamous nonkeratinized epithelium meets stratified columnar

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15
Q

what is barrett’s esophagus?

A

metaplastic simple columnar epithelium with goblet cells and adenocarcinoma

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16
Q

what is necessary for the diagnosis of barrett’s esophagus? what stain is used and what component does it stain?

A
  1. presence of goblet cells

2. alcian blue - stains acidic mucosubstances secreted by goblet cells

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17
Q

what third of the esophagus will harbor an adenocarcinoma?

A

distal third

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18
Q

what type of cancer would most likely cause hoarseness?

A

squamous cell carcinoma

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19
Q

where are the four esophageal constrictions?

A
  1. UES
  2. aortic arch
  3. primary bronchus
  4. diaphragm
20
Q

men are how many times more likely to have stratified squamous cell carcinoma of the esophagus than women?

A

4x

21
Q

african americans are how many times more likely to have stratified squamous cell carcinoma of the esophagus?

A

8x

22
Q

what muscle constitute the inferior pharyngeal constrictor?

A

cricopharyngeus and thyropharyngeus

23
Q

what muscle makes up the superior portion of the inferior constrictor?

A

thyropharyngeus

24
Q

what muscle makes up the inferior portion of the inferior constrictor?

A

cricopharyngeus

25
Q

what is the clinical relevance of the orientation of the cricopharyngeus and thyropharyngeus?

A

potential site of weakness between transition in fiber orientation - Killian’s triangle

diverticulum may form
perforation

26
Q

where does ligation of inferior thyroid artery occur during a thyroidectomy?

A

distal to esophageal branch

27
Q

what is the clinical relevance of venous drainage of the esophagus?

A

portal hypertension with attendant esophageal varices and hematogenous spread of cancer

28
Q

what is the cause of achalasia?

A

loss of inhibitory neurons secreting NO and VIP that populate the myenteric plexus

possibly damage to dorsal motor nucleus of vagus nerve or extraesophageal nerve plexus

29
Q

in which layer of the esophagus does lymph flow most easily? why? what is the clinical significance?

A

submucosal - longitudinally arrayed channels

easier for metastatic spread

30
Q

what is the direction of esophageal lymph flow above and below the bifurcation of the trachea?

A

above - upward

below - downward

31
Q

what is the incisura angularis?

A

external landmark to assist in indentifying the antrum from the body of the stomach

32
Q

where do the majority of peptic ulcers occur?

A

in the vicinity of the incisura angularis (lesser curvature near gastric notch)

33
Q

parietal cells are influenced by what other cell type in the stomach?

A

gastrin producing cells

34
Q

what is zollinger ellison sydrome? where are these tumors usually located?

A
  1. gastrin producing tumor

2. gastrinoma triangle

35
Q

what are the borders of the gastrinoma triangle? what is within in?

A
  1. junction of cystic duct and common hepatic duct
  2. junction of neck and body of pancreas
  3. junction of 2nd and 3rd parts of duodenum

pancreas, duodenum

36
Q

what are the target cells of a gastrinoma?

A

parietal cells

37
Q

what is the physical manifestation of gastrinomas in zollinger ellison syndrome?

A

prominent rugae due to increased parietal cell mass

38
Q

what are the 6 primary arterial feeders to the stomach?

A
  1. right gastric
  2. left gastric
  3. right gastro-omental
  4. left gastro-omental
  5. gastroduodenal
  6. splenic
39
Q

what should be considered when ligating gastric arteries?

A

anatomical variation - left hepatic artery arising from left gastric

40
Q

each vagal trunk gives rise to what nerve innervating the stomach?

A

left and right gastric nerves

41
Q

what are the nerves of Laterjet?

A

anterior and posterior gastric nerves

42
Q

which nerves are preserved in surgery for refractory PUD?

A

crows feet nerves supplying pylorus

43
Q

what is the reason for vagotomy of the stomach? what nerves are resected?

A

denervation regions containing acid secreting parietal cells

44
Q

how may gastric cancer progress to pancreatic duct obstruction?

A

lymph drainage along greater curvature into those at head of pancreas

or, mass effect of tumor growing into pancreas

45
Q

what are the four signature histologic changes of celiac sprue?

A

arrayed enterocytes
villus atrophy
crypt hyperplasia
inflammation of lamina propria

Year 2 Gastrointestinal (38 decks)

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