GA GI Organs Flashcards
At what spine segment level is the esophagus?
T10-T11
At what spine segment level is the stomach?
T11
At what spine segment level is the pylorus?
L1
What important ligament is attached to the esophagus and what is its function?
The phrenico-esophageal ligament
(Phrenic = diaphragm)
Binds the esophagus to the diaphragm
What two nerves travel with the esophagus as it descends through the diaphragm?
The Anterior and Posterior Vagal trunks
What happens with a Cervical Esphageal Constriction, what structures are involved?
Cervical Esophageal Constriction is a result of the closing of the Upper Esophageal Sphincter (which is controlled by the Cricopharyngeus Muscle
What happens with a Thoracic Esophageal Constriction, what structures are involved?
Thoracic Esophageal Constriction occurs as a result of contact with the Left Main Bronchus and the Aorta
What happens with a Diaphragmatic Esophageal Constriction, what structures are involved?
Diaphragmatic Esophageal Constriction occurs as a result of contact with the diaphragm as the esophagus passes through the Esophageal Hiatus at T10.
Also occurs as a result of complications with the Lower Esophageal Sphincter
Implicated in Hiatal Hernias
What is a Paraesophageal Hiatal Hernia?
Hiatal Hernia is when abdominal structures enter the thorax (commonly occurs on the left side)
Paraesophageal Hiatal Hernias occur when the FUNDUS of the stomach protrudes into the thorax adjacent to the esophagus
Note the Gastroesophageal Junction is normal and there is lesser chance of developing GERD with this particular form of Hiatal Hernia
What is a Sliding Hiatal Hernia?
Hiatal Hernia is when abdominal structures enter the thorax (commonly occurs on the left side)
Sliding Hiatal Hernias occur when the CARDIA of the stomach protrudes into the thorax, causing the stomach to have an Hour Glass shape
This is the most common form of Hiatal Hernia and results in the displacement of the Gastoresophageal Junction superiorly.
What are the 5 parts of the stomach?
Cardia Fundus Body Pyloric Antrum Pyloric Canal
What structure(s) will you find anteriorly to the stomach?
Left Lobe of the Liver
Diaphragm
Anterior Abdominal Wall
What structure(s) will you find infero-laterally to the stomach?
The transverse Colon
What structure(s) will you find posteriorly to the stomach?
Left Kidney
Left Suprarenal Gland
Pancreas
Spleen
Diaphragm
Omental Bursa (lesser sac)
- Stomach serves as the anterior wall of the lesser
sacWhat two ligaments are found attached to the stomach and what is their purpose?
Gastrohepatic Ligament - Connects lesser curvature of the stomach to the Liver
- Gastric vessels follow this ligament (including the Left Gastric A
Gastrocolic Ligament - Connects the greater curvature of the stomach to the transverse colon
- The Gastroepiploic vessels follow this ligament
- Also this ligament is part of the Greater Omentum
What is a Gastric Ulcer?
When the acid of the stomach pierces through the wall of the stomach
70% of stomach ulcers are related to H pylori bacteria
Complications can arise if the ulcer occurs at the lesser curvature of the stomach where leaking acid can cause damage to the Left Gastric A., causing hemorrhage.
What is a Peptic/Duodenal Ulcer?
Acid from the stomach breaches through the wall of the pylorus or the duodenum
90% of Peptic/Duodenal Ulcers are related to H pylori bacteria
65% of cases have the ulcer on the posterior side of the 1st part of the duodenum, which can cause hemorrhage by damaging the Gastroduodenal A.
If anterior wall is breached, the pancreas can be affected
What is the purpose of a vagatomy?
Vagatomy is when the vagus is surgically severed
Parasympathetic innervation from the vagus nerve to the parietal cells of the Body and Fundus of the stomach promote acid secretion.
Thus Vagatomies are used as a treatment for ulcers by blocking parasympathetic promotion of acid secretion.
What are the 3 types of Vagotomies and how are they different?
Truncal Vagotomy: Surgical section of vagal trunk; not preferred as this would sever innervation to other abdominal organs besides the stomach
Selective Gastric Vagotomy: Surgical section of vagus nerve, completely denervating the stomach (without compromising the function of other abdominal organs)
Selective Proximal Vagotomy: Surgical section of nerves specifically innervating parietal cells, without compromising other autonomic functions of the stomach (such as motility)
What is the Hepatoduodenal Ligament and what is its function?
Hepatoduodenal Ligament connects the Duodenum to the Liver (resides in the 1st part of the Duodenum)
It is important because it contains:
Proper Hepatic A.
Hepatic Portal V.
Common Bile Duct
It also marks the entrance to the Lesser Sac
What is the Major Duodenal Papilla, where is it located, and what is its function?
Major Duodenal Papilla is the opening found in the 2nd part of the duodenum where Bile and Pancreatic secretions enter the small intestine
What vessels surround the 3rd part of the Duodenum?
Posteriorly there is the Inferior Vena Cava
Anteriorly there is the Superior Mesenteric A. and the Superior Mesenteric V.
Note: Superior Mesenteric A. can cause a bowel obstruction at the 3rd part of the Duodenum
What structure holds the 4th part of the duodenum in place?
The Suspensory M., aka The Ligament of Treitz
Connects the 4th Part of the Duodenum to the Right Crus of the Diaphragm (where the esophagus passes through)
Ligament of Treitz is clinicallt significant in that it is the barrier that separates upper and lower GI.
What are the 3 segments of the small intestine in order?
Duodenum
Jejunum
Ileum
Which abdominal quadrant is most of the Jejunum found?
The Left Upper Quadrant (LUQ)
Which abdominal quadrant is most of the Ileum found?
The Right Lower Quadrant (RLQ)
What features should be found when identifying the Jejunum?
The Vasa Recta (vessels just outside of the intestinal wall) are LONG
The Arcades (vessels forming loops inferior to vasa recta) are FEW and form LARGE LOOPS
Plicae Circulares (Circular folds on the inside wall of the intestine) are LARGE, TALL, and CLOSELY PACKED
Peyers Patches (Lymphoid Nodules on the inside of intestinal wall) are FEW
What features should be found when identifying the Ileum?
The Vasa Recta (vessels just outside of the intestinal wall) are SHORT
The Arcades (vessels fromin loops inferior to vasa recta) are MANY SHORT LOOPS
Plicae Circulares (circular folds on the inside of the intestinal wall) are LOW AND SPARSE or even ABSENT
Peyers Patches (Lymphoid Nodules on the inside of the intestinal wall) are MANY
What is a Meckel Diverticulum?
AKA the Ileal Diverticulum - most common congenital anomaly of GI tract
Typically asymptomatic, unless ectopic gastric or pancreatic tissue are contained
It is a TRUE diverticulum (meaning it contains all tissue layers; mucosa, submucosa, and muscularis)
The diverticulum is a persistent vitelline/embryonic omphalo-mesentreic duct
Most common pathologic lead point for Intussusception
What is Intussusception?
When a proximal segment of the bowel is telescoping into a distal segment of the bowel
Common at the Ileocecal junction
Look for “Target Sign” on Ultrasound
What is the line of muscles that follows along the midline of the large intestine?
Tenia Coli
What do you call the pouches of fat on either side of the Tenia Coli?
Omental Appendices
What are the outcropings that pattern along the large intestine called?
Haustra
What is Volvulus?
Volvulus is when the colon twists and rotates to form a loop that can cause constipation, ischemia and necrosis.
Midgut Volvulus is more common in infants
Sigmoid Colon Volvulus are more common in elderly
Shows up as a coffee bean sign on X-ray
What structure separates the Right and Left ANATOMIC Lobes of the Liver and what is its function?
The Falciform Ligament, it attaches the liver to the anterior abdominal wall
What are the 2 accessory lobes, where are they located, and what is significant about each?
They are the Quadrate Lobe and the Caudate Lobe, both are found on the Right lobe of the liver.
The Quadrate lobe, while physically part of the right lobe, is FUNCTIONALLY part of the left lobe (Left Hemi-liver)
The Caudate Lobe, while physically part of the right lobe, is functionally SEPARATE from both the Left and Right lobe.
What are the 4 main ligaments of the Liver?
Hepatoduodenal Ligament
Round Ligament
Falciform Ligament
Ligamentum Venosum
What is the Round ligament a remnant of?
Round ligament is the remnant of the umbilical vein
What is the Ligamentum Venosum a remnant of?
The Ligamentum Venosum is a remnant of the ductus venosus
What separates the Left and Right FUNCTIONAL lobes of the liver?
Cantlie Line (line from fundus of gallbladder to diaphragm)
Which Segments of the liver belong to which functional lobe?
Segments II, III, and IV belong to the LEFT FUNCTIONAL lobe
Segments V, VI, VII, and VIII belong to the RIGHT FUNCTIONAL lobe
Segment I is the Caudate Accessory lobe and it is functionally separate from the left and right functional lobes.
What are the three parts of the Gallbladder?
Fundus
Body
Neck
What are the Two ducts that drain bile from the gallbladder into the duodenum?
Cystic Duct
Common Bile Duct
What is the hole that allows bile and pancreatic secretions enter the duodenum called, and which segment of the duodenum is it located?
Ampulla of Vater (or the Hepatopancreatic Ampulla)
Second part of the duodenum
What is Cholelithiasis?
Gallstone
What is Cholecystitis?
Gallstone obstructing the cystic duct, causing inflammation in the Gallbladder
What are the 4 F’s describing typical Cholecystitis patients?
Female
Fourty
Fertile (has had children)
Fat
What is Murphy’s sign and what does a positive result tell you?
RUQ palpation during inhalation
If patient suddenly stops inhaling due to pain, Murphy’s sign is positive, telling us patient has cholecystitis
What is Choledocolithiasis?
Gallstone obstructing the common bile duct
What is Gallstone Ileus?
If a gallstone is causing excessive inflammation of gallbladder, the gallbladder can adhere to the duodenum.
The gallstone can then perforate through the fused gallbladder/duodenum wall, travel all the way down through the small intestine and block the ileocecal junction.
What structure(s) are anterior to the spleen?
Stomach
What structure(s) are lateral to the spleen?
Diaphragm
Ribs (9-11)
What structure(s) are medial to the spleen?
Left kidney
What structure(s) are inferior to the spleen?
Left colic flexure (transition point from tranverse colon to descending colon)
What ligaments are attached to the spleen and what is important about each?
Splenorenal Ligament - Connects the Spleen witht he left kidney.
- Carries the Splenic artery; the major blood supply for the spleen
Gastrosplenic Ligament - Connects the Spleen with the stomach
- Carries the Short Gastric arteries (branch off the Splenic A.); Supply the Fundus of the stomach and superior portion of the Spleen
