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
2
Q
What does fasciculata make?
A
Cortisol and sex hormones
3
Q
What controls Chromaffin cells?
A
Preganglionic sympathetic fibers
4
Q
Most common adrenal medulla tumors in adults and children
A
Adults: pheo
Children: neuroblastoma, rarely causes HTN
5
Q
mnemonic for adrenal cortex
A
GFR
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.
7
Q
Name of post. pituitary
A
Neurohypophysis
8
Q
Name of ant. pituitary
A
adenohypophysis
9
Q
Post. and ant. pituitary derived from what tissues
A
post. from neuroectoderm and ant. from ectoderm (Rathke pouch)
10
Q
How does oxytocin and ADH move into post. pituitary
A
Shuttled from hypothalamus via neurophysins (carrier proteins)
11
Q
alpha subunit common to what hormones
A
TSH, LH, FSH, hCG
12
Q
What does beta subunit of hormones do
A
Determines hormone specificity
13
Q
What are the acidophils
A
GH, prolactin
14
Q
What are the basophils
A
B-FLAT: Basophils-FSH, LH, ACTH, TSH
15
Q
What is the mnemonic for the pituitary hormones
A
FLAT PiG: FSH, LH, ACTH, TSH, Prolactin, GH
Also through melanotropin (MSH)
16
Q
Where can you find alpha cells in islets
A
Peripheral
17
Q
WHere are beta cells in islets
A
central
18
Q
where are delta cells in islets
A
Interspersed: somatostatin
19
Q
What makes something retroperitoneal?
A
it lacks a mesentery or is a non-GI structures
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)
21
Q
Where does pancreas lie?
A
Over the IVC and aorta
22
Q
Know the important GI ligaments
A
……..
23
Q
What is in hepatoduodenal ligament
A
Portal triad: proper hepatic artery, portal vein, common bile duct.
24
Q
What is in falciform ligament
A
Ligamentum teres hepatis (derivative of fetal umbilical vein)
25
What is the Pringle maneuver.
Ligament compressed between thumb and index finger placed in omental foramen to control bleeding.
26
What does hepatoduodenal ligament border
Borders omental foramen, which connects the greater and lesser sacs
27
What is the greater and lesser sacs
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.
28
What does greater omentum connect to
Connects to greater curvature of stomach and to the transverse mesocolon.
29
What is in gastrohepatic ligament
Gastric arteries
30
What do you cut to get access into the lesser sac
The gastrohepatic ligament
31
What in gastrocolic ligament
Gastroepiploics: part of greater omentum
32
What is in gastrosplenic ligament
Short gastrics, left gastroepiploic vessels.
33
What is in splenorenal ligament
Splenic artery and vein, tail of pancreas
34
What does splenorenal connect
Spleen to post. abd. wall
35
What separates greater and lesser sac on the Right and the Left
On the R: gastrohepatic
| On the L: Gastrosplenic.
36
What are the layers of the GI tube from inside out
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)
37
Difference between ulcers and erosions
Ulcers can extend into submucosa, inner or outer muscular layer. Erosions are in the mucosa only.
38
Frequencies of basal electric rhythm (slow waves)
Stomach: 3 waves/min
Duodenum: 12 waves/min
Ileum: 8-9 waves/min
39
Histo of duodenum
Brunner glands (submucosa) and crypts of Lieberkuhn
40
Histo of jejunum
Plicae circulares and crypts of Lieberkuhn
41
Ileum histo
Peyer patches (lamina propria, submucosa), plicae circulares (proximal ileum), and crypts of Lieberkuhn.
42
What has largest number of goblet cells in the small intestine?
Ileum
43
Colon histo
Crypts of Lieberkuhn but no villi, numerous goblet cells
44
Crypts of Lieberkuhn
AKA Intestinal gland of the small intestine to secrete mucus and alkaline.
45
Peyer's patches
Aggregations of lymhoid tissue only in the ileum, not the duodenum or jejunum.
46
Brunner glands
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
Celiac trunk spinal level
T12
48
SMA spinal level
L1
49
Renal artery spinal level
L1 (below SMA)
50
IMA spinal level
L3
51
Bifurcation of abd. aorta spinal level
"Bifourcation" of abd. aorta (L4)
52
Where does middle sacral artery branch off
The bifurcation
53
SMA syndrome
Transverse (3rd) part of duodenum caught by SMA and aorta causing intestinal obstruction.
54
Nerves of the guts
Vagus supplies foregut and midgut, Pelvic supplies hindgut.
55
Vertebral level of the guts
Fore: T12/L1
Mid: L1
Hind: L3
56
Foregut
Pharynx to proximal duodenum (liver, gallbladder, pancreas, spleen (mesoderm)
57
Midgut
Distal duodenum to proximal 2/3 of transverse colon
58
Hindgut
Distal 1/3 of transverse colon to upper portion of rectum
59
What supplies lesser curvature of stomach
The R and L gastrics
60
What supplies greater curvature
The R and L gastroepiploics
61
Where do the short gastrics come off of
Splenic vein
62
What are the branches of the SMA
common hepatic, splenic, Left gastric
63
Where does R gastric come off of
Proper hepatic artery
64
What does common hepatic break off into
Proper hepatic and gastroduodenal
65
What branches off gastroduodenal
The R gastroepiploic and the ant./post. superior pancreaticoduodenal artery
66
What arteries have poor anastomoses
Short gastrics if splenic is blocked
67
Name some collateral circulations
```
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
What is the coronary vein
Left gastric vein
69
What is the superior rectal vein also called
Superior hemorrhoidal vein
70
Site of anatamoses in cirrhosis
Gut: gastric/duodenal varices
Butt: Rectal veins (not internal hemorrhoids)
Caput: Paraumbilical veins
71
Gut varices
left gastric-esophageal
72
Caput medusae
Paraumbilical vein - small epigastrics beins of the anterior abd. wall
73
Rectal varcies
Superior rectal vein- middle and inferior rectal veins
74
TIPS spelled out and connection
Transjugular Intrahepatic Portosystemic shunt: Portal vein to Hepatic vein
75
What is the Pectinate line?
Also known as dentate line: Where endoderm (hindgut) meets ectoderm
76
What is above pectinate line
Internal hemorrhoids, adenocarcinoma
77
Above pectinate line blood and lymph
Superior rectal artery (IMA): drains to superior rectal vein into inferior mesenteric vein into portal system.
Deep lymph nodes
78
Below pectinate line blood and lymph
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
What is below pectinate line?
External hemorrhoids, anal fissures, squamous cell carcinoma
80
What is in anal fissure
Tear in the anal mucosa below the Pectinate line. pain while pooping; blood on paper. Located Posteriorly since this area is poorly perfused.
81
What lines sinusoids of liver?
Fenestrated endothelium.
82
Kupffer cells function
Located in the sinusoids to destroy foreign material like bacteria. Specialized macrophages.
83
Space of Disse function
Separates sinusoids from the hepatocytes, it contains blood plasma and hepatocytes have microvilli to absorb stuff from it.
84
Hepatocytes orientation towards sinusoids
Apical to bile canaliculi, basolateral to sinusoids.
85
Flow of blood vs. bile
Reverse directions. Bile moves towards Zone I, blood moves towards Zone III
86
Zone I anatomy
periportal zone: branch of portal vein and hepatic artery and bile ductule (portal triad)
87
Zone II anatomy
intermediate zone (sinusoids)
88
Zone III anatomy
Pericentral vein (centrilobular zone)
89
Zone I pathology
```
Affected 1st by viral hepatitis.
Ingested toxins (e.g. cocaine)
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90
Zone III pathology
Affected 1st by ischemia
Contains P-450 system
most sensitive to metabolic toxins
Site of alcoholic hepatitis
91
read more about the zones
....
92
Reticuloendothelial system
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
Where is the central vein
In zone III, leads up to hepatic veins and systemic circulation.
94
Femoral region mnemonic
Lateral to medial: NAVEL (move lateral to medial to find your navel)
Nerve, artery, vein, empty space, lymphatic
95
Femoral triangle borders
inguinal ligament, medial: adductor longus, lateral: sartorius
96
Femoral sheath
Fascial tube 3-4 cm below inguinal ligament. Contains femoral vein, artery, and canal (deep inguinal lymph nodes) but not femoral nerve.
97
What does femoral triangle contain
Femoral vein, artery, and nerve: Venous near the penis.
98
What are the layers of the abd. wall?
Parietal peritoneum, extraperitoneal tissue, transversalis fascia, transversus abdominis muscle, internal oblique muscle, aponeurosis of external oblique muscle.
99
What is the conjoined tendon made from
The transversus abdominis muscle and internal oblique muscle.
100
Function of the pyramidalis muscle
Overlies the rectus abdominis muscle: tenses the linea alba
101
What makes up the layers of the spermatic cord
3 layers: Internal spermatic fascia (transversalis fascia), cremasteric muscle and fascia (internal oblique), external spermatic fascia (external oblique)
102
Median or medial umbilical ligament is more lateral
MediaL is more lateral
103
What is the most common diaphragmatic hernia?
Sliding hiatal hernia: GEJ displaced upwards: "hourglass stomach"
104
Paraesophageal hernia
GEJ is normal. Fundus protrudes into thorax.
105
Indirect inguinal hernia path
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
Hesselbach triangle borders
rectus abdominis, lateral border of rectus abdominis, inferior epigastrics
107
Direct hernia
Herniates through hesselbach's triangle, goes through external ring, so only external spermatic fascia (external oblique fascia). Medial to inferior epigastrics. Older men.
108
Femoral hernia
Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle. More common in females.
109
What hernia is leading cause of bowel incarceration.
Femoral hernia.
