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Gastrointestinal System > EXAM #1: UPPER GI ANATOMY > Flashcards

EXAM #1: UPPER GI ANATOMY Flashcards

1
Q

What are the four layers of the GI tube?

A

1) Mucosa
2) Submucosa
3) Muscularis externa/ propria
4) Serosa

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2
Q

What are the four layers of the mucosa?

A
  • Epithelium is in contact with chyme
  • Basal lamina
  • Lamina propria
  • Muscularis mucosae
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3
Q

What are the two layers of the muscularis externa/ propria?

A
  • Inner circular

- Outer longitudinal

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4
Q

Where in the mucosa are lymphatics, nerves, blood vessels, and glands located?

A

Lamina propria

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5
Q

In what two segments of the GI tube are glands in the submucosa?

A

Esophagus

Duodenum

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6
Q

What are the two plexus of the GI tube?

A
  • Submucosal–inner

- Myenteric–outer

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7
Q

What is the eponym for the Submucosal plexus?

A

Meissner’s plexus

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8
Q

What is the eponym for the Myenteric plexus?

A

Auerbach’s plexus

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9
Q

What is the function of the submucosal plexus?

A

Ion and fluid movement

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10
Q

What is the function of Meissner’s plexus?

A

Motility

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11
Q

What is the normal type of epithelium in the esophagus? Stomach? Describe their appearance.

A

Esophagus= Nonkeratinized stratified squamous epithelium (pale)

Stomach= Non-ciliated simple columnar epithelium with goblet cells(red/ tongue-like)

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12
Q

What is the name of the transition between the epithelium of the esophagus and stomach?

A

Z-line

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13
Q

What is Barrett’s esophagus?

A

Metaplasia in the distal esophagus with simple columnar epithelium with goblet cells in response to GERD

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14
Q

How is Barret’s Esophagus diagnosed?

A

ALCAIN BLUE staining

  • Goblet cells in esophagus will produce mucous
  • alcain blue stains mucous
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15
Q

What cancer are patients with Barett’s Esophagus at risk for?

A

Adenocarcinoma

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16
Q

What third of the esophagus is most likely to harbor an adenocarcinoma?

A

Distal 1/3

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17
Q

What third of the esophagus is most likely to harbor a squamous cell carcinoma (SCC)?

A

Middle 1/3

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18
Q

What patient populations are at risk for stratified squamous cell carcinoma?

A

Males
African Americans
Smokers
Drinkers

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19
Q

What type of esophageal cancer is most likely to cause hoarseness? Why?

A

SCC

**Middle 1/3 of the esophagus is in close proximity to the recurrent laryngeal nerve of the vagus (innervates the larynx) ***

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20
Q

Generally, how is SCC staged?

A

The deeper the penetration of the esophageal walls, the higher the stage

Stage 4 has completely penetrated

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21
Q

What histologic characteristic of the esophagus lends it to metastasis?

A

Lack of a serosa to contain the cancer

22
Q

What are the four anatomic esophageal constrictions?

A

1) Upper Esophageal Sphincter
2) Aortic arch crosses the esophagus
3) Left Bronchus
4) Esophageal hiatus

23
Q

How do the clinical constrictions of the esophagus differ from the anatomic?

A

Only 3x

–> Aortic arch and left bonchus are combined

24
Q

What vertebral level is the esophageal hiatus located at?

A

T10

25
Q

What is the clinical consideration that you need to keep in mind about the constrictions of the esophagus?

A

Be weary of constrictions on endoscopy i.e. don’t force and penetrate the wall of the esophagus

26
Q

What is pill esophagitis?

A

Difficulty swallowing pills in the elderly leading to inflammation of the esophagus

27
Q

Where is there an anatomic weakness in the esophagus prone to developing a diverticula?

A

Inferior border of the pharynx, specifically between the oblique thyropharyngeus and cricopharyngeus

28
Q

What is the eponym for the triangle between the thyropharyngeus and cricopharyngeus?

A

Killian’s Triangle

29
Q

What is the eponym for the diverticula that develops at Killian’s Triangle?

A

Zenker’s Diverticulum

30
Q

What is the main symptom of a Zenker’s Diverticulum?

A

Halitosis

31
Q

Where would you ligate the inferior thyroid artery when performing a thyroidectomy?

A

Above/ distal to the esophageal branch of the inferior thyroid artery

32
Q

What does cirrhosis/ portal hypertension lead to in the esophagus?

A

Esophageal varices

33
Q

What is achalasia?

A
  • Inhibitory neurons of Meissner’s plexus have been destroyed
  • Normally relaxes the Lower Esophageal Sphincter

–>Abnormally contracted LES leading to proximal esophageal dilation

34
Q

Describe the lymphatic vessels of the esophagus. How does this differ from the colon?

A

Lymph flow moves LONGITUDINALLY i.e. the length of the esophagus in the SUBMUCOSA

**Colon lymph flow is RADIAL

35
Q

What are the clinical implications of the direction of lymph flow in the esophagus?

A

Metastatic cells can travel cranially or caudally

36
Q

Where does metastasis travel more commonly in the superior esophagus?

A

Cranially into the cervical lymph nodes

37
Q

Where does metastasis travel more commonly in the inferior esophagus?

A

Caudally into the celiac trunk

38
Q

What is a chylothroax? What causes a chylothorax?

A

Damage to the throacic duct during esophageal surgery spills lymph into the throacic cavity

39
Q

What type of glands are in the pyloric area of the stomach?

A

Gastrin secreting G-cells

40
Q

What is the function of Gastrin?

A

Increases the secretion of HCl from parietal cells

41
Q

What is the surgical procedure that can be done for refractory PUD?

A

Surgical excision of the pylorus to decrease the number of gastrin secreting G-cells

42
Q

Where are most ulcers found in the stomach?

A

Lesser curvature proximal to the angular notch

43
Q

What is the angular notch?

A

Interface between the body of the stomach and the pylorus

44
Q

What is Zollinger-Ellison Syndrome?

A

Tumor of gastrin producing cells, a Gastrinoma

45
Q

What is the most common location for a Gastrinoma?

A

Gastrinoma Triangle, which is defined as:

1) Junction of cystic and common hepatic duct
2) Junction of neck and body of pancreas
3) Junction between 2nd and 3rd part of the duodenum

46
Q

What are the contents of the Gastrinoma Triangle?

A

Pancreas

Duodenum

47
Q

What gross change of the stomach is seen in Zollinger-Ellison Syndrome?

A

Prominent rugae due to increased parietal cell mass

48
Q

Review the arterial supply of the stomach.

A

N/A

49
Q

What are the six major arteries the supply the stomach?

A

1) Right gastric
2) Left gastric
3) R. gastro-omental
4) L. gastro-omental
5) Gastroduodenal
6) Splenic

50
Q

What arterial variation do you need to be weary of in a gastrectomy?

A

Left hepatic artery can branch from the left gastric artery–impairing blood supply to the left lobe of the liver.

Gastrointestinal System (42 decks)

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