First Aid: Gastrointestinal Flashcards
What is gastroschisis?
Extrusion of abdominal contents through abdominal folds (intestines are exposed and NOT covered by peritoneum)
What is an Omphalocele?
Persistence of herniation of abdominal contents into umbilical cord. Failure of intestines to RETURN to body cavity. Contents ARE COVERED by peritoneum and amnion.
After feeding her newborn for the first time, a mother notices the baby is drooling, choking and vomiting. You notice abdominal distension. What sign could the child have presented during the pregnancy that would help identify the disease? What test would you do next?
Esophageal Atresia with distal Tracheoesophageal Fistula (TEF)
Polyhydramnios because fetus couldn’t swallow amniotic fluid.
Try to pass nasogastric tube into stomach to confirm
A baby boy presents two weeks after birth. You notice nonbilious projectile vomiting and an olive-like mass in the epigastric region. Peristalsis is visible through the abdominal wall. What should be done next?
Pyloric stenosis from congenital hypertrophy of smooth muscle of the pyloric sphincter.
Image the child to confirm and do a myotomy to surgically repaire
What is an annular pancreas?
What is pancreas divisum?
Annular pancreas is when ventral pancreatic bud abnormally encircles the 2nd part of duodenum forming a ring of pancreatic tissue. May cause narrowing of small bowel.
Pancreas divisum is when ventral and dorsal parts fail to fuse at 8 weeks.
What are the structures in the retroperitoneal space?
SAD PUCKER
Suprarenal (adrenal) glands Aorta and IVC Duodenum (2nd-4th parts) Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys Esophagus (lower 2/3) Rectum (partially)
You are doing a cholesystectomy procedure when you notice excessive bleeding occurring in the surgical site, possibly from the liver. What surgical maneuver, taking advantage of anatomical structures, would help control the bleeding?
Pringle maneuver - compressing hepatoduodenal ligament (which contains proper hepatic hartery, common bile duct, and portal vein) between thumb and index finger placed in omental foramen (also could use a soft hemostat).
What ligament may be cut during surgery to access the lesser peritoneal sac?
Gastrohepatic (connects liver to lesser curvature of stomach) and contains gastric arteries. Separates greater and lesser sacs on the right.
What are the four layers of the digestive tract, and what do they contain/function?
MSMS - inside out
Mucosa - epithelium (absorption), lamina propria (support), muscularis mucosa (motility)
Submucosa - submucosal nerve plexus (meissner)
Muscularis externa - includes myenteric nerve plexus (Auerbach’s), inner longitudinal and outer circular muscle layers
Serosa (when intraperitoneal)/Adventitia when retroperitoneal.
What layers of the GI tract will ulcers affect? How about erosions?
Erosions affect only the mucosa
Ulcers can extend into submucosa, inner or outer muscle layers.
In cases when an artery is blocked or damaged, anastomeses can be very helpful in keeping an organ perfused. Which arteries branching off of the celiac trunk have strong anastomeses, and which have poor?
Strong anastamoses between:
- Left and right gastroepiploics
- Left and right gastrics
Short gastrics provide poor anastamoses to spleen if the splenic artery is cut.
What clinical signs are commonly seen with portal hypertension?
Varices of GUT, BUTT, and CAPUT (medusae):
Gut = EsophaGUS (from left gastric –> esophageal)
Butt = Rectum (from IMV –> superior rectal vein)
Caput medusae =Umbilicus (from paraumbilical vein)
What treatment can be used to relieve portal hypertension?
transjugular intrahepatic portosystemic shunt (TIPS) between portal and hepatic veins relieves by shunting portal blood to systemic circulation
What is the key symptomatic difference between hemorrhoids above and below the pectinate line?
Above (internal hemorrhoids) is not painful because visceral innervation
Below (external hemorrhoids) is painful because somatic innervation
Also venous and lymphatic drainages are different.
What are the key signs and symptoms of an anal fissure?
The P’s:
below the Pectinate line. Pain while Pooping. blood on toilet Paper. located Posteriorly since this area is Poorly Perfused.
Which liver zone is most at risk for ischemia? What 3 characteristics are unique about this area?
Zone III: pericentral vein (centrilobular) zone
Contains cytochrome p450 esystem
Most sensitive to metabolic toxins
Site of Alcoholic hepatitis
Which structure in the biliary system can cause the most problems if blocked by a stone? What is another pathology that can occur in this area that disrupts biliary function?
Gallstones that reach the common channel at ampulla of Vater can block BOTH bile and pancreatic ducts
Tumors of head of pancreas (near duodenum) can obstruct common bile duct.
What is the difference between an indirect and direct inguinal hernia? Through what opening do femoral hernias protrude?
Indirect protrudes through the internal inguinal ring while Direct protrudes through abdominal wall via the weak area of Hesselbach’s (inguinal) triangle.
Femoral hernias protrude through femoral ring which contain the lymphatics (most medial, preceded by Vein, artery and nerve most lateral)
Which pathological conditions will increase gastrin levels the most?
Zollinger Ellison syndrome the most
Chronic PPI use
Phenylalanine and tryptophan are potent stimulators.
A patient presents with copious Watery Diarrhea, Hypokalemia, and Achlorhydria. What GI regulatory substance is most likely the cause for this presentation?
Vasoactive intestinal polypeptide (VIP) will increase if patient has a “VIPoma”, a non-alpha non-beta islet cell pancreatic tumor that secretes VIP.
WDHA syndrome results in the symptoms described.
What regulators will increase and decrease gastric acid levels? What pathology will increase gastrin acid resulting in ulcers that are refractory to medical therapy?
Histamine, ACh and Gastrin are major upregulators of gastric acid.
Somatostatin, GIP, prostaglandins, and secretin are downregulators.
Gastrinoma is a gastrin secreting tumor that will increase gastric acid.
Where in the stomach are Chief cells and Parietal cells located? Where does gastrin predominantly act to increase gastric acid levels?
the Body
Gastrin primarily acts on enterochromaffin-like (ECL) cells –> leading to histamine release –> activating parietal cells to increase acid secretion
Which enzymes are primarily released in pancreatic secretions?
alpha-amylase for starch digestion
Lipases for fat digestion
Proteases for protein digestion
Trypsinogen which becomes trypsin
What are the main clinically useful inhibitory sites in the gastric parietal cell?
Atropine at ACh receptor on basal side
H2 blockers at Histamine receptor on basal side
Prostaglandins which inhibit intracellular cAMP formation
Proton pump inhibitors which block ATPases on luminal surface
Where are Peyer patches located and what do they secrete? What pathology can result from these sites?
Lymphoid tissue found in lamina propria and submucosa of ILEUM.
B-cells become –> IgA secreting plasma cells –> Release IgA
Peyer patches can become large and inflamed following viral infection and can get hooked during peristalsis and pushed into cecum resulting in INTUSSUCEPTION
