Formative Flashcards
Which veins drain blood from the liver to the IVC
Which vein drains blood from the GIT/spleen to the liver?
Hepatic veins
Hepatic portal vein
the Liver is suspended in the abdominal cavity by the Falciform, Coronary and Triangular ligaments.
How else is the Liver suspended?
The hepatic veins draining blood from the Liver into the IVC help to suspend the Liver in the abdominal cavity.
In embryological terms, what is the Falciform ligament a remnant of?
The Falciform ligament is a remnant of the Ventral mesogastrium of the foregut
The Liver develops in this mesentery dividing it up into the Falciform ligament (Anterior wall- Liver) Lesser Omentum (Liver-Stomach
What embryological remnant lies within the Falciform ligament?
The Umbilical vein lies within the Ventral mesogastrium during development.
It remains as the Ligamentum teres (also called the round ligament of the Liver)
If a gallstone were to get stuck in any structures on its way to the duodenum:
What structures would it lass through
what clinical condition might result in each case
Cystic duct- Cholecystitis/ Biliary colic
Common bile duct- Cholangitis/Jaundice
Ampulla de vater/sphincter of oddi- Cholangitis/Jaundice/pancreatitis/steatorrhoea
Name the three paired salivary glands
Which of these glands secretes a mainly serous fluid?
Parotid
Sublingual
Submandibular/Submaxilliary
The Parotid secretes a mainly serous fluid
The Acinar cells of the salivary glands produce a fluid that is initially isotonic (with plasma), but the end product is a solution that is hypotonic.
Explain the process of producing hypotonic saliva
Ductal modification:
More ions (Na+/Cl-) reabsorbed from saliva than secreted into saliva
Ductal cells relatively impermeable to water
Overall effect = more ions removed from saliva than water = hypotonic
What happens to the tonicity of saliva when the flow rate increases?
Explain why
Increases
Less contact time with ductal cells/ Less time for ductal modification/ reduced reabsorption of Na/Cl
What happens to the alkalinity of saliva as the flow rate increases?
Explain why
Increases
Ductal HCO3- secretion is selectively stimulated when saliva production is stimulated
Describe causes of dysphagia where swallowing solids is harder than
swallowing liquids
Dry mouth
Any physical obstruction from the oral cavity to the gastro-oesophageal junction i.e. various cancers (usually squamous cell carcinoma or adenocarcinoma)
fibrous strictures
external compression from structures surrounding the oesophagus
suitable investigation for Dysphagia to solid foods
Barium swallow
Oesophago-gastro-duodenoscopy (OGD)
Accept Videofluoroscopy
CXR- for external compression
What is the Peritoneal cavity?
What does it normally contain?
Is the Peritoneal cavity an enclosed space?
the space that lies between the Visceral and Parietal peritoneum
A small amount of fluid (normally sterile)
In males it is an enclosed space
in females it is open to the external environment via the infundibulum of the Fallopian tubes
What differences exist in the abdominal wall above and below the arcuate line (line of Douglas)?
The Rectus muscles are surrounded by the aponeurosis of the other abdominal wall muscles;
- both anterior and posterior to them above the arcuate line
- only anterior below it below the arcuate line
A patient complains of vague central (peri-umbilical) abdominal pain.
Using just this information what can you deduce about the possible location of the patients pathology.
Explain why
The pathology probably lies within the embryological mid-gut derivatives of the abdominal cavity.
Intra-peritoneal midgut structures will convey a vague periumbilical pain when pathology is irritating/distending their visceral peritoneum
What is a Meckel’s diverticulum?
Where is it normally located?
a diverticulum that exists because of the incomplete obliteration of the vitelline duct (omphalomesenteric duct)
Usually found within 2 feet (proximal) of the Ileo-caecal valve.
With reference to local organs, describe the site of the lesser sac.
How does the lesser sac form during development in the human?
The lesser sac lies posterior to the Liver , the lesser omentum and the stomach
The foregut has both a Ventral and a Dorsal attachment to the abdominal cavity. When the foregut rotates an enclosed space is created posterior to the stomach. This becomes the lesser sac.
If you were to insert the tip of your finger in the epiploic foramen (foramen of Winslow or entrance to lesser sac), name three tubular structures that would be lying in the peritoneum in front (anterior to) of your finger.
Common Hepatic artery
common Bile duct
Portal vein
In pancreatitis, how does fluid come to collect in the lesser sac?
When a patient develops a large fluid collection in the general peritoneal cavity, what is the condition called?
The lesser sac lies immediately anterior to the Pancreas. During pancreatitis, the Pancreas releases (extravasates) pancreatic secretions into its surroundings and some move through into the lesser sac, where they collect.
Ascites
The Pancreas secretes both enzyme rich secretions and Bicarbonate rich secretions.
Name the hormones that are responsible for stimulating these.
Enzyme rich- Cholecystokinin (CCK)
Bicarbonate rich- Secretin
Explain why a cancer of the head of the pancreas should cause a patient to be jaundiced
A cancer in the head of the Pancreas can obstruct the common bile duct as it enters the duodenum.
This will stop bile from following its normal passage into the gut causing a backlog of Bile within the biliary system.
As a consequence of this, constituents of bile like Bilirubin will be reabsorbed into the blood causing a Hyperbilirubinaemia, which is
basis of Jaundice.
Which one of these does not contribute to the patency of the Lower oesophageal sphincter?
A The right crus of the diaphragm
B Positive intra-abdominal pressure acting on abdominal oesophagus
C Acute angle of entry (oesophagus into stomach)
D Pyloric sphincter
E Mucosal fold at Oesphagogastric junction
D
The Pyloric sphincter is the muscular sphincter that determines the rate that chime is delivered into the duodenum
and plays no part in the Lower oesophageal sphincter.
The other answers are all factors that help prevent reflux of gastric contents into the oesophagus.
If GORD continues over a period of time there is a risk that epithelial cells in the Oesophagus may
undergo Metaplasia.
Which of the following statements is true for Metaplasia?
A Irreversible B Involves undifferentiated cells C Always results in cancer D Is synonymous with dysplasia E Involves differentiated cells
E
This is an important term to be able to define. Metaplasia is the reversible change of one differentiated cell type with
another differentiated cell type.
The problem is that if prolonged this can lead to dysplasia and neoplasia and so metaplasia in the oesophagus is seen
as a potential precursor for oesophageal cancer. We call this Barrett’s oesophagus. The normal pinkish white
squamous epithelium is replaced with salmon pink columnar cells.
Ongoing Epigastric pain results in this gentleman undergoing an upper GI tract endoscopy in which
a gastric ulcer is visualised.
Statistically where is the most likely region of the stomach for an ulcer to develop?
A Cardia B Fundus C Body-lesser curve D Body-greater curve E Antrum
C
The most common site of gastric ulceration is the lesser curve of the body of the stomach.
The most common site of peptic ulceration overall is the first part of the duodenum as this is where the acidic chyme
enters the duodenum.
The neutralising pancreatic fluid and bile only join the duodenum later in the 2nd part so the first part is susceptible to
acidic damage and ulceration.
Although unlikely, if a stomach ulcer where to erode posteriorly through the body of the stomach
which major artery may be at risk from haemorrhage?
A Left gastro-epiploic B Right gastric C Splenic artery D Gastro-duodenal E Right gastro-epiploic
Which vessel would be damaged if a duodenal ulcer eroded through the first part of the duodenum?
C
Gastro-duodenal artery
The Parietal cells in the stomach are responsible for acid production and which other important
substance from the list below?
A Gastrin B Intrinsic factor C Histamine D Pepsinogen E Secretin
B
Gastrin is released from G cells
Histamine (in a gut context) is released by Enterochromaffin like cells (ECL cell)
Pepsinogen is released by chief cells
Secretin is released by S cells.
Which of the following blood vessels are involved in the formation of oesophageal varices?
A Left Gastric artery B Left Gastric vein C Left Gastro-epiploic artery D Right Gastic vein E Short Gastric vein
B
The Left gastric vein drains into the Portal vein and is the one from this list most involved in the formation of varices.
Arteries are not involved in forming varices.
Which of the following (plasma) test results would be the most specific indicator of Hepatocyte damage?
A Raised Alanine Transaminase (ALT)
B Raised Albumin levels
C Raised Alkaline Phosphatase (ALP)
D Raised Aspartate Aminotransferase (AST)
E Raised conjugated Bilirubin levels
A
There is a short podcast on LFTs which can be found on Blackboard.
Alanine transaminase (ALT) is specific to hepatocytes and so if they are damaged it is released into plasma.
ALP tends to rise in biliary obstruction and bone disease.
AST is raised in liver damage but is also present in reasonable quantities in cardiac and skeletal muscle and so is not
that specific to the liver.
The healthy liver produces albumin so hepatocyte damage will not result in more albumin
Raised conjugated Bilirubin levels is seen more in Biliary obstruction that occurs after conjugation has occurred
(common bile duct blockage etc).
Which of the following (plasma) test results would be the most reliable indicator of a gallstone stuck in the
common bile duct?
A Raised Alanine Transaminase (ALT)
B Raised Albumin levels
C Raised Alkaline Phosphatase (ALP)
D Raised Aspartate Aminotransferase (AST)
E Raised conjugated Bilirubin levels
E
There is a short podcast on LFTs which can be found on Blackboard.
Alanine transaminase (ALT) is specific to hepatocytes and so if they are damaged it is released into plasma.
ALP tends to rise in biliary obstruction and bone disease.
AST is raised in liver damage but is also present in reasonable quantities in cardiac and skeletal muscle and so is not
that specific to the liver.
The healthy liver produces albumin so hepatocyte damage will not result in more albumin
Raised conjugated Bilirubin levels is seen more in Biliary obstruction that occurs after conjugation has occurred
(common bile duct blockage etc).
What is the clinical significance of the Paracolic gutters?
A They allow the circulation of normal peritoneal fluid
B They allow infectious fluids to travel to sites remote from the organ of origin
C They stop infectious fluids from travelling to sites remote from the organ of origin
D The demarcate the lateral borders of the peritoneal cavity
E The provide structural support for the ascending/descending colon
B
The paracolic gutters are formed between the lateral portions of the ascending and descending colon and the walls of
the abdominal cavity. They are inside the peritoneal cavity.
The allow infected fluid to move from the pelvis up the sides of the peritoneal cavity to the sub diaphragmatic
recesses or the Hepato-renal recess (pouch of Morrison….James Rutherford!).
The also allow contents from a perforated bowel to travel distant to the perforation.
This is when knowledge of the recesses in the peritoneal cavity becomes useful as fluid can collect in them….please
know about the pouch of Douglas and utero-vesical pouch.
Which of the following characteristics would indicate a diagnosis of Ulcerative colitis as opposed to
Crohn’s disease?
A Presence of disease in the rectum
B Presence of disease in the terminal ileum
C Presence of fistulas
D Presence of Perianal disease
E Presence of skip lesions
A
