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Step 1 > Endocrine and GI Anatomy > Flashcards

Endocrine and GI Anatomy Flashcards

1
Q

What is primary control of Zona Glomerulosa, Fasciculata, and Reticularis?

A

G: Renin-Angiotensin
F: ACTH, CRH
R: ACTH, CRH

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2
Q

What does fasciculata make?

A

Cortisol and sex hormones

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3
Q

What controls Chromaffin cells?

A

Preganglionic sympathetic fibers

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4
Q

Most common adrenal medulla tumors in adults and children

A

Adults: pheo
Children: neuroblastoma, rarely causes HTN

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5
Q

mnemonic for adrenal cortex

A

GFR

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6
Q

Adrenals venous drainage

A

Like the gonad veins, the R adrenal vein goes to the IVC, the L adrenal vein goes to the L kidney.

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7
Q

Name of post. pituitary

A

Neurohypophysis

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8
Q

Name of ant. pituitary

A

adenohypophysis

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9
Q

Post. and ant. pituitary derived from what tissues

A

post. from neuroectoderm and ant. from ectoderm (Rathke pouch)

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10
Q

How does oxytocin and ADH move into post. pituitary

A

Shuttled from hypothalamus via neurophysins (carrier proteins)

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11
Q

alpha subunit common to what hormones

A

TSH, LH, FSH, hCG

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12
Q

What does beta subunit of hormones do

A

Determines hormone specificity

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13
Q

What are the acidophils

A

GH, prolactin

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14
Q

What are the basophils

A

B-FLAT: Basophils-FSH, LH, ACTH, TSH

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15
Q

What is the mnemonic for the pituitary hormones

A

FLAT PiG: FSH, LH, ACTH, TSH, Prolactin, GH

Also through melanotropin (MSH)

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16
Q

Where can you find alpha cells in islets

A

Peripheral

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17
Q

WHere are beta cells in islets

A

central

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18
Q

where are delta cells in islets

A

Interspersed: somatostatin

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19
Q

What makes something retroperitoneal?

A

it lacks a mesentery or is a non-GI structures

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20
Q

Retroperitoneal organ mnemonic

A 
SAD PUCKER:
Suprarenal glands (adrenals)
Aorta and IVC
Duodenum (2nd through 4th parts)
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus: lower 2/3
Rectum (partially)
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21
Q

Where does pancreas lie?

A

Over the IVC and aorta

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22
Q

Know the important GI ligaments

A

……..

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23
Q

What is in hepatoduodenal ligament

A

Portal triad: proper hepatic artery, portal vein, common bile duct.

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24
Q

What is in falciform ligament

A

Ligamentum teres hepatis (derivative of fetal umbilical vein)

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25
Q

What is the Pringle maneuver.

A

Ligament compressed between thumb and index finger placed in omental foramen to control bleeding.

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26
Q

What does hepatoduodenal ligament border

A

Borders omental foramen, which connects the greater and lesser sacs

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27
Q

What is the greater and lesser sacs

A

The greater sac is the cavity of the entire abdominal cavity except for the lesser sac. The lesser sac is entered through the omental foramen and is small: behind the stomach and in front of the pancreas. Superior border is lesser omentum and inferior border is greater omentum.

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28
Q

What does greater omentum connect to

A

Connects to greater curvature of stomach and to the transverse mesocolon.

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29
Q

What is in gastrohepatic ligament

A

Gastric arteries

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30
Q

What do you cut to get access into the lesser sac

A

The gastrohepatic ligament

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31
Q

What in gastrocolic ligament

A

Gastroepiploics: part of greater omentum

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32
Q

What is in gastrosplenic ligament

A

Short gastrics, left gastroepiploic vessels.

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33
Q

What is in splenorenal ligament

A

Splenic artery and vein, tail of pancreas

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34
Q

What does splenorenal connect

A

Spleen to post. abd. wall

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35
Q

What separates greater and lesser sac on the Right and the Left

A

On the R: gastrohepatic

On the L: Gastrosplenic.

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36
Q

What are the layers of the GI tube from inside out

A

MSMS
Mucosa: epithelium, lamina propria, muscularis mucosa
Submucosa: submusocal nerve plexus (Meissner’s_
Muscularis Externa: Myenteric nerve plexus (Auerbach): Circular on inside and Longitudinal on outside
Serosa (intraperitoneal)/Adventitia (retroperitoneal)

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37
Q

Difference between ulcers and erosions

A

Ulcers can extend into submucosa, inner or outer muscular layer. Erosions are in the mucosa only.

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38
Q

Frequencies of basal electric rhythm (slow waves)

A

Stomach: 3 waves/min
Duodenum: 12 waves/min
Ileum: 8-9 waves/min

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39
Q

Histo of duodenum

A

Brunner glands (submucosa) and crypts of Lieberkuhn

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40
Q

Histo of jejunum

A

Plicae circulares and crypts of Lieberkuhn

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41
Q

Ileum histo

A

Peyer patches (lamina propria, submucosa), plicae circulares (proximal ileum), and crypts of Lieberkuhn.

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42
Q

What has largest number of goblet cells in the small intestine?

A

Ileum

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43
Q

Colon histo

A

Crypts of Lieberkuhn but no villi, numerous goblet cells

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44
Q

Crypts of Lieberkuhn

A

AKA Intestinal gland of the small intestine to secrete mucus and alkaline.

45
Q

Peyer’s patches

A

Aggregations of lymhoid tissue only in the ileum, not the duodenum or jejunum.

46
Q

Brunner glands

A

Found above Sphincter of Oddi: secretes mucus rich bicarb secretion to protect from stomach acid in duodenum, activate intestinal enzymes, and lubricate intestinal walls.

47
Q

Celiac trunk spinal level

A

T12

48
Q

SMA spinal level

A

L1

49
Q

Renal artery spinal level

A

L1 (below SMA)

50
Q

IMA spinal level

A

L3

51
Q

Bifurcation of abd. aorta spinal level

A

“Bifourcation” of abd. aorta (L4)

52
Q

Where does middle sacral artery branch off

A

The bifurcation

53
Q

SMA syndrome

A

Transverse (3rd) part of duodenum caught by SMA and aorta causing intestinal obstruction.

54
Q

Nerves of the guts

A

Vagus supplies foregut and midgut, Pelvic supplies hindgut.

55
Q

Vertebral level of the guts

A

Fore: T12/L1
Mid: L1
Hind: L3

56
Q

Foregut

A

Pharynx to proximal duodenum (liver, gallbladder, pancreas, spleen (mesoderm)

57
Q

Midgut

A

Distal duodenum to proximal 2/3 of transverse colon

58
Q

Hindgut

A

Distal 1/3 of transverse colon to upper portion of rectum

59
Q

What supplies lesser curvature of stomach

A

The R and L gastrics

60
Q

What supplies greater curvature

A

The R and L gastroepiploics

61
Q

Where do the short gastrics come off of

A

Splenic vein

62
Q

What are the branches of the SMA

A

common hepatic, splenic, Left gastric

63
Q

Where does R gastric come off of

A

Proper hepatic artery

64
Q

What does common hepatic break off into

A

Proper hepatic and gastroduodenal

65
Q

What branches off gastroduodenal

A

The R gastroepiploic and the ant./post. superior pancreaticoduodenal artery

66
Q

What arteries have poor anastomoses

A

Short gastrics if splenic is blocked

67
Q

Name some collateral circulations

A 
Middle colic (SMA)--Left Colic (IMA)
Superior pancreaticoduodenal (celiac)--inferior pancreaticoduodenal (SMA)
Superior epigastrics (internal thoracic/mammary)--inferior epigastrics (external iliac)
Superior rectal (IMA)--middle and inferior rectal (internal iliac)
68
Q

What is the coronary vein

A

Left gastric vein

69
Q

What is the superior rectal vein also called

A

Superior hemorrhoidal vein

70
Q

Site of anatamoses in cirrhosis

A

Gut: gastric/duodenal varices
Butt: Rectal veins (not internal hemorrhoids)
Caput: Paraumbilical veins

71
Q

Gut varices

A

left gastric-esophageal

72
Q

Caput medusae

A

Paraumbilical vein - small epigastrics beins of the anterior abd. wall

73
Q

Rectal varcies

A

Superior rectal vein- middle and inferior rectal veins

74
Q

TIPS spelled out and connection

A

Transjugular Intrahepatic Portosystemic shunt: Portal vein to Hepatic vein

75
Q

What is the Pectinate line?

A

Also known as dentate line: Where endoderm (hindgut) meets ectoderm

76
Q

What is above pectinate line

A

Internal hemorrhoids, adenocarcinoma

77
Q

Above pectinate line blood and lymph

A

Superior rectal artery (IMA): drains to superior rectal vein into inferior mesenteric vein into portal system.
Deep lymph nodes

78
Q

Below pectinate line blood and lymph

A

Inferior rectal artery (internal pudendal artery). Venous drainage to inferior rectal vein to internal pudendal vein to internal iliac vein to IVC. Lymph drainage to superficial inguinal nodes.

79
Q

What is below pectinate line?

A

External hemorrhoids, anal fissures, squamous cell carcinoma

80
Q

What is in anal fissure

A

Tear in the anal mucosa below the Pectinate line. pain while pooping; blood on paper. Located Posteriorly since this area is poorly perfused.

81
Q

What lines sinusoids of liver?

A

Fenestrated endothelium.

82
Q

Kupffer cells function

A

Located in the sinusoids to destroy foreign material like bacteria. Specialized macrophages.

83
Q

Space of Disse function

A

Separates sinusoids from the hepatocytes, it contains blood plasma and hepatocytes have microvilli to absorb stuff from it.

84
Q

Hepatocytes orientation towards sinusoids

A

Apical to bile canaliculi, basolateral to sinusoids.

85
Q

Flow of blood vs. bile

A

Reverse directions. Bile moves towards Zone I, blood moves towards Zone III

86
Q

Zone I anatomy

A

periportal zone: branch of portal vein and hepatic artery and bile ductule (portal triad)

87
Q

Zone II anatomy

A

intermediate zone (sinusoids)

88
Q

Zone III anatomy

A

Pericentral vein (centrilobular zone)

89
Q

Zone I pathology

A 
Affected 1st by viral hepatitis. 
Ingested toxins (e.g. cocaine)
90
Q

Zone III pathology

A

Affected 1st by ischemia
Contains P-450 system
most sensitive to metabolic toxins
Site of alcoholic hepatitis

91
Q

read more about the zones

A

….

92
Q

Reticuloendothelial system

A

AKA mononuclear phagocyte system. The system of macrophages and monocytes throughout the body that eats up stuff. Mostly spleen and lymph nodes, but also liver (Kuppfer cells), skin, lung, etc.

93
Q

Where is the central vein

A

In zone III, leads up to hepatic veins and systemic circulation.

94
Q

Femoral region mnemonic

A

Lateral to medial: NAVEL (move lateral to medial to find your navel)
Nerve, artery, vein, empty space, lymphatic

95
Q

Femoral triangle borders

A

inguinal ligament, medial: adductor longus, lateral: sartorius

96
Q

Femoral sheath

A

Fascial tube 3-4 cm below inguinal ligament. Contains femoral vein, artery, and canal (deep inguinal lymph nodes) but not femoral nerve.

97
Q

What does femoral triangle contain

A

Femoral vein, artery, and nerve: Venous near the penis.

98
Q

What are the layers of the abd. wall?

A

Parietal peritoneum, extraperitoneal tissue, transversalis fascia, transversus abdominis muscle, internal oblique muscle, aponeurosis of external oblique muscle.

99
Q

What is the conjoined tendon made from

A

The transversus abdominis muscle and internal oblique muscle.

100
Q

Function of the pyramidalis muscle

A

Overlies the rectus abdominis muscle: tenses the linea alba

101
Q

What makes up the layers of the spermatic cord

A

3 layers: Internal spermatic fascia (transversalis fascia), cremasteric muscle and fascia (internal oblique), external spermatic fascia (external oblique)

102
Q

Median or medial umbilical ligament is more lateral

A

MediaL is more lateral

103
Q

What is the most common diaphragmatic hernia?

A

Sliding hiatal hernia: GEJ displaced upwards: “hourglass stomach”

104
Q

Paraesophageal hernia

A

GEJ is normal. Fundus protrudes into thorax.

105
Q

Indirect inguinal hernia path

A

Occurs in infants. Enters deep inguinal ring, through external inguinal ring, into the scrotum through the processus vaginalis. Enters lateral to inferior epigastrics. Covered by all three layers of spermatic cord.

106
Q

Hesselbach triangle borders

A

rectus abdominis, lateral border of rectus abdominis, inferior epigastrics

107
Q

Direct hernia

A

Herniates through hesselbach’s triangle, goes through external ring, so only external spermatic fascia (external oblique fascia). Medial to inferior epigastrics. Older men.

108
Q

Femoral hernia

A

Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle. More common in females.

109
Q

What hernia is leading cause of bowel incarceration.

A

Femoral hernia.

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