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GI Midterm > DSA: Organs of the GI Tract > Flashcards

DSA: Organs of the GI Tract Flashcards

1
Q

The thoracic esophagus pierces the diaphragm at _____ through the esophageal hiatus slightly left of midline

It turns sharply left to enter the stomach at the cardiac orifice about vertebra level _____

A

T10

T11

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2
Q

What are the 3 constrictions of the esophagus and what forms them?

A

Cervical constriction aka UES (crycopharyngeus m.)

Thoracic aka bronchoaortic constriction (L main bronchus + aortic arch)

Diaphragmatic constriction (R crus of diaphragm)

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3
Q

Describe para-esophageal hiatal hernia. Does the patient experience regurg?

A

Cardia of stomach is normal position, but peritoneum and fundus protrude anterior to esophagus

No regurgitation!

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4
Q

Describe sliding hiatal hernia. Does the patient experience regurg?

A

Esophagus, cardia, fundus protrude through hiatus

Yes there is regurgitation, worse with lying down

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5
Q

Which is more common, sliding or paraesophageal hiatal hernia?

A

Sliding hiatal hernia

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6
Q

In which quadrant(s) of the abdomen would you find the stomach?

A

Most commonly in right and left UQs

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7
Q

The left end of the stomach (fundus) is typically fixed at vertebral level ____, and the right end (pylorus) is fixed at _____

The area between is variable

A

T10-11; L1

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8
Q

Anterior relationships of stomach

A

Anterior abdominal wall
Diaphgram
L lobe of liver

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9
Q

Posterior relationships of stomach

A 
Diaphragm
Spleen (posterior and lateral)
L suprarenal gland
L upper kidney
Pancreas
Transverse colon (inferior and lateral)
Transverse mesocolon
Omental bursa (lesser sac)
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10
Q

The duodenum begins at the pylorus at the level of ____ and ends at the _______ flexure (junction) at L2

A

L1; duodenojejunal

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11
Q

The duodenum is subdivided into how many parts? Are the intraperitoneal or retroperitoneal?

A

4: superior, descending, horizontal/inferior, and ascending

First part (superior) is intraperitoneal; 2-4th are retroperitoneal

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12
Q

Which anatomical region of the duodenum is common for ulcerations and subsequent bleeding to occur?

A

Duodenal bulb

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13
Q

The hepatoduodenal ligament is associated with the ____ part of the duodenum and contains the portal triad.

What is contained in the portal triad?

A

1st

Portal vein
Hepatic artery
Bile duct

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14
Q

The head of what organ sits just inferior to the 1st part of the duodenum?

A

Pancreas

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15
Q

The bile duct and pancreatic ducts enter the ____ part of the duodenum at the _____ _____

A

2nd; duodenal papilla

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16
Q

A tumor in the head of the pancreas would likely block what important anatomical structure?

A

Common bile duct

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17
Q

Medial, anterior, and posterior relationships of the 2nd part of the duodenum

A

Medial: head of pancreas

Anterior: gallbladder (fundus), R lobe of liver, transverse colon

Posterior: right kidney and ureter

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18
Q

The superior mesenteric artery and vein, as well as the root of the mesentery, cross anteriorly over which part of the duodenum?

A

3rd part

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19
Q

Superior and anterior relationships of 3rd part of duodenum

A

Superior: head of pancreas

Anterior: jejunum

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20
Q

Vascular compression disorder referring to compression of left renal vein between superior mesenteric artery and aorta leading to renal venous HTN, rupture of veins in collecting system, and hematuria

A

Nutcracker syndrome

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21
Q

Posterior and anterior relationships of 4th part of duodenum

A

Posterior: left margin of aorta, inferior mesenteric vein, and psoas muscle

Anterior: root of mesentery and jejunum

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22
Q

The 4th part of the duodenum is held in place by what structure?

A

Suspensory ligament of duodenum = ligament of Treitz

Anchors 4th part ot right crus of diaphragm

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23
Q

In which abdominal quadrant would you find the jejunum

A

LUQ

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24
Q

In which quadrant would you find the ileum

A

RLQ

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25
Q

Both the jejunum and ileum are intraperitoneal, held in place by what?

A

The mesentery

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26
Q

Which makes up more of the small intestine, jejunum or ileum?

A

Ileum

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27
Q

Compare the vascular arcades, vasa recta, and general vascularization of the jejunum vs. the ileum

A

Jejunum = simple vascular arcades, long vasa recta, more vascular

Ileum = compound vascular arcades, shorter vasa recta, less vascular

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28
Q

Compare the diameter, thickenss, and plicae circularis in the jejunum vs. the ileum

A

Jejunum = greater diameter, thicker, more plicae circularis

Ileum = smaller diameter, thinner walls, fewer plicae circularis

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29
Q

Compare amount of lymphoid nodules (peyer patches) found in jejunum vs. ileum

A

Jejunum has few peyer’s patches while the ileum has many

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30
Q

What is the most common congenital anomaly of the small intestine? Which part of the small intestine is affected?

A

Meckel’s diverticulum, affecting the ileum (arises from the antimesenteric border of ileum) as a remnant of the vitelline duct

May contain other types of tissue like gastric, pancreatic, and/or jejunal

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31
Q

Meckel’s diverticulum is clinically difficult to distinguish from what other condition?

A

Appendicitis

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32
Q

What is the rule of 2’s referring to Meckel’s diverticulum?

A

Occurs in 1–2% of population

About 2 feet from ileocecal junction

Average of about 2 inches long

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33
Q

THE mesentery is what attaches the jejunum and ileum to the posterior body wall

Between the 2 layers of THE mesentery, are the _______ artery, lymph nodes, fat, and autonomic nerves

A

Superior mesenteric

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34
Q

THE mesentery crosses which major anatomical structures?

A 
L2-L5
3rd and 4th part of duodenum
Abdominal aorta
IVC
R ureter
R psoas major
R gonadal vessels
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35
Q

Name the regions of the large intestine

A 
Cecum
Appendix
Ascending colon
Right colic (hepatic) flexure
Transverse colon
Left colic (splenic) flexure
Descending colon
Sigmoid colon
Rectum
Anal canal
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36
Q

3 major features of large intestine

A

Taenia coli
Haustrae
Appendices (epiploicae)

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37
Q

_____ are 3 bands of longitudinal muscle on the outside of the colon that converge at the root of the appendix and produce sacculations called ________

A

Taenia coli; haustrae

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38
Q

What are the tags of fat on the large intestine called?

A

Appendices or epiploicae

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39
Q

T/F: the cecum tends to have abundant epiploic appendages

A

False, no epiploic appendages on the cecum!

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40
Q

Where is McBurney’s point? (Used to identify location of appendix)

A

1/3 of the way from the right ASIS on the spinoumbilical line

41
Q

The cecum is a blind “pouch” inferior to the _____ orifice

The __________ is a cone-like projection of the ileum into the cecum, inferior to which is the opening for the ______

A

Ileocecal

Ileal papilla; appendix

42
Q

The appendix is usually attached to the posterior-medial part of the cecum. It is located at the junction of 3 _______ and is supported by the _______

A

Taenia coli; mesoappendix

43
Q

Are the 4 parts of the colon intraperitoneal or retroperitoneal? (What is each one?)

A

Ascending colon = secondarily retroperitoneal, except for the cecum

Transverse colon = intraperitoneal (transverse mesocolon)

Descending colon = secondarily retroperitoneal

Sigmoid colon = intraperitoneal (sigmoid mesocolon)

44
Q

Which part of the colon is commonly affected by diverticulosis?

A

Sigmoid - most commonly on the mesenteric side of the 2 non-mesenteric teniae coli, where nutrient arteries perforate the muscle coat to reach the submucosa

45
Q

What is volvulus of the sigmoid colon?

A

Rotation and twisting of the sigmoid colon resulting in obstruction of the lumen proximal to the twisted segment

Constipation may lead to fecal compaction, ischemia may result in necrosis

46
Q

The rectum is found between the sigmoid colon and anal canal.

The _______ line is a line joining the tops of the anal columns, and the rectum is superior to it.

A

Anorectal

47
Q

What are the transverse rectal folds

A

Folds that overlie the thickened parts of the circular muscles layer of the rectum (superior, intermediate, and inferior)

48
Q

_____ = dilated terminal part of the rectum

A

Rectal ampulla

49
Q

Where are the anal valves found

A

At the base of the anal columns

50
Q

What are the anal sinuses

A

Spaces between and at the inferior part of the anal columns

51
Q

______ line = a ling joining the inferior ends of the anal valves

A

Pectinate

52
Q

The spleen is found in the left _____ region, paralleling ribs ____-____ at the midaxillary line, between the stomach and diaphragm

A

Hypochondriac; 9-11

53
Q

T/F: the spleen is normally not palpable below the costal margin

A

True

54
Q

The spleen is intraperitoneal, bound by what 2 ligaments?

A

Gastrosplenic

Splenorenal

55
Q

Anterior, posterior, inferior, and medial relationships of the spleen

A

Anterior = stomach, tail of pancreas

Posterior = diaphragm

Inferior = left colic flexure

Medial = L kidney, phrenicocolic ligament

56
Q

The pancreas is retroperitoneal except for the tail. It is located at vertebral level _____

A

L1-L2

57
Q

4 parts of pancreas

A

Head with uncinate process located in duodenal curve

Neck

Body

Tail (intraperitoneal with splenorenal lig)

58
Q

Where is the uncinate process of the pancreas n relation to the SMA and V?

A

Uncinated process is posterior to SMA and V

59
Q

Where is the tail of the pancreas in relation to the hilum of the spleen?

A

Anterior to the hilum of the spleen

60
Q

Anterior relationships of pancreas

A

Lesser sac and stomach

61
Q

Posterior relationships of pancreas

A 
Aorta and IVC
Splenic v.
Bile duct
R crus of diaphragm
L kidney and vessels
L suprarenal gland
SMA and SMV
62
Q

Right, left, and inferior relationships of pancreas

A

Right = 2nd part of duodenum

Left = spleen

Inferior = 3rd part of duodenum

63
Q

Describe pancreatic duct system including main duct, bile duct, and accessory duct

A

The main pancreatic duct joins the bile duct and they enter 2nd part of duodenum together through a common hepatopancreatic ampulla, this forms the major duodenal papilla (of Vater)

The accessory pancreatic duct may or may not be present - it enters the duodenum at the more superior minor duodenal papilla

64
Q

Most of the liver is located in which quadrant?

A

RUQ

[the left lobe is located in the LUQ]

65
Q

4 anatomic lobes of the liver

A

Left lobe
Right lobe
Caudate lobe
Quadrate lobe

66
Q

What ligament divides the right and left hepatic lobes?

A

Falciform ligament

67
Q

There are 4 anatomical lobes of the liver, but the liver can also be divided into functional lobes which are what are used clinically. What are these lobes based on?

A

Based on division of the portal triad and blood supply

68
Q

For functional lobes of the liver, the right and left side are divided by the _____ line. Segment I is the _____ lobe. The other segments of the liver are either right or left.

Which segments of the functional liver are part of the left liver? The right?

A

Cantile; caudate

Left liver = segments II, III, and IV

Right liver = segments V, VI, VII, and VIII

69
Q

The left liver contains segments II, III, and IV. The right liver contains segments V, VI, VII, and VIII. What are these functional segments called?

A

Left liver:
Segment II = left posterior lateral segment
Segment III = left anterior lateral segment
Segment IV = left medial segment

Right liver:
Segment V = right anterior medial segment
Segment VI = right anterior lateral segment
Segment VII = right posterior lateral segment
Segment VIII = right posterior medial segment

70
Q

The _____ ligament (ventral mesentery) is a double layer of peritoneum that connects the liver to the anterior abdominal wall

A

Falciform

71
Q

The falciform ligament contains the _________

A

Ligamentum teres (aka round ligament of the liver)

72
Q

What are all the ligaments associated with the liver

A

Falciform (contains ligamentum teres)

Lesser omentum with hepatoduodenal ligament and hepatogastric ligaments

Coronary ligaments

R and L triangular ligaments

73
Q

2 major surfaces of the liver

A

Diaphragmatic surface

Visceral surface

74
Q

The diaphragmatic surface of the liver is smooth and fits the concavity of the diaphragm. It is covered by _____ peritoneum, except posteriorly in the bare area.

The bare area is defined by anterior, posterior, left, and right ______ ligaments. It includes an area where the _____ is posterior to the liver and the hepatic veins drain into it.

A

Visceral

Coronary; IVC

75
Q

The visceral surface of the liver contains the ________, which is the transverse fissure between the caudate and quadrate lobes and transmits the portal triad

The visceral surface also contains the ______ (remnant of obliterated umbilical vein) in the edge of the falciform ligament, as well as the ______ which is the remnant of the obliterated ductus venosus and used to connect the umbilical vein with the IVC

The hepatic fossa is the space for the ______

A

Porta hepatis

Ligamentum teres; ligamentum venosum

Gallbladder

76
Q

The gallbladder contacts the anterior abdominal wall at the ___ costal cartilage.

What are the 3 parts of the gallbladder?

A

9th

Fundus
Body
Neck

77
Q

What are the extrahepatic bile passages

A 
R hepatic duct
L hepatic duct
Common hepatic duct
Cystic duct
Bile duct
78
Q

Describe the bile duct in relation to the duodenum and pancreas

A

Bile duct is posterior to the 1st part of duodenum and the head of the pancreas

It enters the 2nd part of the duodenum with the pancreatic duct

79
Q

______ = gallstones, which are made up of ____ crystals

What are the 3 major places where gallstones may become lodged?

A

Cholelithiasis; cholesterol

Cystic duct, hepatic duct, hepatopancreatic ampulla

80
Q

Describe possible result of gallstone blocking the cystic duct

A

Cholecystitis = inflammation of the gallbladder leading to biliary colic (intense spasmodic pain)

On PE, patient is ill-appearing, febrile, and tachycardic. True local parietal peritoneal inflammation will be aggravated by movement with voluntary and involuntary guarding.

Positive Murphy’s sign

81
Q

Describe possible result of gallstone blocking the hepatopancreatic ampulla

A

This would block both the bile duct and the pancreatic duct

Bile may backup into pancreas and cause pancreatitis

Patient may also be jaundiced, which would not occur with cystic duct blockage

82
Q

A patient with hx of gallstones presents with symptoms consistent with biliary colic and jaundice. You diagnose them with a gallstone blockage, where is the most likely location of the blockage?

A

Hepatopancreatic ampulla, because you would not become jaundiced with a blockage in the cystic duct

83
Q

A ______ results when inflammation of the gallbladder leads to adhesions to other organs

A

Cholecystoenteric fistula

84
Q

Which organs are most likely to be affected by cholecystoenteric fistula?

A

Superior duodenum

Transverse colon

85
Q

If gallstones enter the intestine, where else might the gallstones cause a blockage?

A

Ileocecal junction

86
Q

The esophagus enters the abdomen at the tip of the left ___ costal cartilage (vertebral level T10), and enters the stomach at the tip of the left ____ costal cartilage (vertebral level T11)

A

7th; 8th

87
Q

Which part of the duodenum is the longest?

A

3rd part = 4 inches

[1st part is 2”, 2nd part is 3”, 4th part is 1”]

88
Q

Duodenum:

First part is directed backward at _____ plane (vertebral level L1)

Second part is directed inferiorly to ______ plane (vertebral level L3)

Third part is directed horizontally to left side of vertebral level ____

Fourth part is directed superiorly to left side of vertebral level _____

A

Transpyloric

Subcostal

L3

L2

89
Q

The root of mesentery of small intestine starts to the left of vertebral level ___ and ends at the _____ plane lateral to right side of linea semilunaris (vertebral level L5)

A

L2; transtubercular

90
Q

The ileocecal valve is at the level of the _____ plane, lateral to the linea semilunaris at L5

A

Transtubercular

91
Q

What are the planes used as reference points of the abdomen and their corresponding vertebral levels?

A 
T9 = xiphisternal
T11
L1 = transpyloric
L3 = subcostal
L5 = transtubercular
S2 = interspinous
Suprapubic
92
Q

The cecum is at the level of the _____ plane, lateral to the right linea semilunaris

A

Transtubercular

93
Q

The ascending colon starts at the ____ and ends at the hepatic flexure at the level of the ____ plane lateral to the right linea semilunaris

A

Cecum; transpyloric

94
Q

The transverse colon starts at the hepatic flexure and ends at the ____ flexure at vertebral level ___, lateral to left linea semilunaris

A

Splenic; T12

95
Q

The descending colon starts at the splenic flexure and descends to the iliac crest, lateral to left linea semilunaris. It ends medial to left linea semilunaris on ______ plane

A

Transtubercular

96
Q

The sigmoid colon starts on the transtubercular plane and ends midline below the ____ plane

A

Interspinous

97
Q

The upper border of the liver is in the _____ plane to the left linea semilunaris

The lower border of the liver goes from right costal margin to tip of right ____ costal cartilage to tip of left ___ costal cartilage to upper border

A

Xiphisternal

9th; 8th

98
Q

The gallbaldder is located at the tip of ____ costal cartilage at the ____ plane

A

9th; transpyloric

GI Midterm (14 decks)

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