First Aid - GI

Question 1

Retroperitoneal structures

Answer 1

SAD PUCKER:
Suprarenal (adrenal) glands
Aorta/IVC
Duodenum (parts 2+3)
Pancreas
Ureters
Colon
Kidneys
Esophagus (lower 2/3)
Rectum
injury to these-> blood or gas in retroperitoneal space

Question 2

Layers of gut wall

Answer 2

MSMS:
Mucosa (absorptive epithelium)
Submucosa- contains Messner's plexus
Muscularis externa- includes Auerbach's plexus
Serosa

Question 3

GI blood supply/innervation

Answer 3

Foregut (stomach to proximal duodenum: celiac artery/ganglion
Midgut (distal duodenum to proximal 2/3 of transverse colon): superior mesenteric artery/ganglion
Hindgut: (distal 1/3 of transverse colon to upper rectum): inferior mesenteric artery/ganglion

Question 4

Branches of celiac trunk

Answer 4

common hepatic, splenic, left gastric (main blood supplies of stomach)

Question 5

Portosystemic anastomoses and clinical signs (esophagus, umbilicus, rectum)

Answer 5

Esophagus: left gastric + esophageal (sign: esophageal varices)
Umbilicus: paraumbilical + (superficial and inferior epigastric below umbilicus) or (superior epigastric and lateral thoracic above) (sign: caput medusae)
Rectum: superior rectal +middle/inferior rectal (sign: internal hemorrhoids)

Question 6

Pectinate line: above (innervation, blood supply and drainage)

Answer 6

visceral innervation (internal hemorrhoids don’t hurt)
superior rectal artery (SMA)
superior rectal vein->IMV->portal system

Question 7

Liver anatomy: Zone 1

Answer 7

periportal zone

affected 1st by viral hepatitis

Question 8

Liver anatomy: Zone 2

Answer 8

intermediate zone

Question 9

Liver anatomy: Zone 3

Answer 9

centrilobular (pericentral) zone
affected 1st by ischemia
contains P450 system
most sensitive to toxins
site of alcoholic hepatitis

Question 10

Pectinate line: blow

Answer 10

inferior rectal branch of pudendal (somatic)- (external hemorrhoids painful)
inferior rectal artery (pudendal)
inferior rectal vein->internal pudendal vein->internal iliac vein->IVC

Question 11

Diaphragmatic hernia (cause)

Answer 11

abdominal structures enter thorax

seen in infants as result of defective pleuroperitoneal membrane development

Question 12

2 common types of diaphragmatic hernias

Answer 12

hiatal hernia - GE junction displaced upwards (hourglass appearance)
paraesophageal hernia - fundus protrudes into thorax (GE normal) (bowel sounds in lung field)

Question 13

Indirect inguinal hernia

Answer 13

travels through deep (internal) inguinal ring, superficial inguinal ring, into scrotum

Question 14

Indirect inguinal hernia - cause

Answer 14

infants- failure of processus vaginalis to close

covered by all 3 layers