Gastro - FA Anat/Phys p352 - 369 Flashcards
extrusion of abdominal contents through abdominal folds but not covered by peritoneum is called?
Gastroschisis
Foregut encompasses what structures?
esophagus to first 1/2 of duodenum
With gastroschisis, what marker is increased?
alpha FP
Midgut encompasses what structures?
2nd 1/2 of duodenum to proximal 2/3 of transverse colon
Hindgut encompasses what structures?
distal 1/3 of transverse colon to anal canal above pectinate line
persistence of herniation of abdominal contents into umbilical cord, sealed by peritoneum is called?
Omphalocele
omphalocele and gastroschisis are both due to what type of defective closure of the anterior abdominal wall?
Lateral fold closure
Pectus excavatum or ectopia cordis due to what type of defective closure of the anterior abdominal wall?
rostral fold closure
Intestinal obstruction in newborn babies who have Down syndrome is due to failure to?
Duodenal atresia due to failure to recanalize. double bubble sign.
Ectopia vesicae is due to
bladder exstrophy is due to Caudal fold closure failure
Bonus q: polyhydramnios is seen with which congenital intestinal abnormalities? (DM mother)
-Anenecephaly - facial cleft - Duodenal atresia - Esophageal atresia - Tracheoesophageal fistula - Diaphragmatic hernias
Exstrophy of the bladder is associated with what other congenital anomaly?
Epispadias
After delivery of a cyanotic baby, doctor fails to pass nasogastric tube into stomach.
Clinical test for Tracheo-Esoph fistula
At — midgut herniates through umbilical ring.
6th week
Cyanosis in TEF is 2° — to avoid reflux-related aspiration.
laryngospasm
At — midgut returns to abdominal cavity + rotates around —-.
10th week SMA
Newborn drools or chokes with first feeding. On Xray, you see air in the stomach. Dx?
Trach-esoph fistula
Apple peel bowel on xray due to a disruption of what vessels?
mesenteric vessel disruption –> ischemic necrosis –> jejunal and ileal atresia.
Which Tracheoesophageal anomalies shows gasless abdomen on CXR?
In pure Esoph Atresia
3 Pathologies due to malrotation of midgut,
- intestinal atresia or stenosis, - volvulus
—- abnormally encircles 2nd part of duodenum; Annular pancreas
ventral pancreatic bud
Pancreas divisum—ventral and dorsal parts fail to fuse at—–.
8 weeks
Spleen—arises in mesentery of stomach hence is —- but is supplied by —-.
mesodermal foregut, celiac artery.
what structures contribute to the pancreatic head?
Both the ventral and dorsal buds
Circumferential ectopic pancreatic tissue can cause what?
Stenosis of second part of duodenum
The dorsal pancreatic bud becomes which structures?
body, tail isthmus accessory pancreatic duct
Hepatoduodenal ligament encompasses what structures?
Portal triad: Proper hepatic artery Common bile duct Portal vein
—- ligament separates greater and lesser sacs on the right and — ligament separates greater and lesser sacs on the Left.
Gastrohepatic GastrospLenic
Describe the Pringle maneuver?
Hepatoduodenal ligament compressed between thumb and index finger at the lesser border of omental foramen to control bleeding.
If after doing Pringle maneuver, bleeding continues, what could be the source of the bleed?
inferior vena cava or the hepatic vein
Which ligament may be cut during surgery to access lesser sac?
Gastrohepatic
Layer that contains Meissner nerve plexus and secretes fluid?
Submucosa
layer that contains Auerbach and is for motility?
Muscularis externa (Myenteric nerve plexus)
which GI structure has the fastest frequency of basal electric rhythm?
Duodenum—12 waves/min
T or F? Brunner glands are only found in duodenum.
T (hypertrophy)
which GI structure has the slowest frequency of basal electric rhythm?
Stomach—3 waves/min
Erosions are in which layer/s?
mucosa only
The only 2 digestive organs not containing crypts of Lieberkühn?
stomach and esophagus
Brunner glands location and function?
HCO3 secreting cells of submucosa of duodenum
Which structure has the largest number of goblet cells in the small intestine?
Ileum
T or F? Peyer patches are found in the same structure as where vit B12 is absorbed.
T
which structure has crypts of Lieberkühn but no villi?
Colon
Describe the Superior mesenteric artery syndrome?
occurs when the transverse portion (third part) of the duodenum is entrapped between SMA and aorta, causing intestinal obstruction.
“Bifourcation” of abdominal aorta happens at what level?
L4
Arteries supplying GI structures branch —-. Arteries supplying non-GI structures branch —- .
anteriorly laterally
Level of transverse portion (third part) of the duodenum?
L1 (Superior mesenteric artery syndrome)
Level Inferior mesenteric artery?
L3
Which nerve is affected in chagas dx?
parasympathetic branches of the vagus nerve
splenic flexure is a watershed region between — and —-.
SMA and IMA
upper portion of rectum is supplied by which artery?
IMA
Due to failure of proper descent of hindgut?
Anal atresia/imperforate anus
which organ has most susceptibility to infarction?
CNS (damage w/ 5 min) Heart (20-30m) Kidney/Spleen Liver and renal unlikely bc dual blood supply
Which structures in the intestine contain stem cells?
crypts of Lieberkühn
list the branches of the celiac trunk
Left gastric artery, splenic artery & common hepatic artery
ulcer at the lesser curvature of the stomach will affect what artery?
L gastric a
Epigastric pain that improves with meals and posterior ulcer, what artery could be damaged?
Gastroduodenal artery
what anastomoses are seen in esophageal varices
left gastric & Azygous
anastomoses between paraumbilical vein to small epigastric vein of the anterior abdominal wall is seen in what clinical sign
caput medusae
what two pathology is seen above the pectinate line?
Adenocarcinoma & internal hemorrhoids
why are internal hemorrhoids not painful
they receive visceral innervation and are therefore not painful
what is the lymphatic drainage above the pectinate line
internal iliac l.n.
what lymphatic drains the testes and ovaries
Para-aortic
what pathology is seen below the pectinate line
ext hemorrhoids, squamous cell cancer, anal fissures
lymphatic drainage below the pectinate line
superficial inguinal nodes
what zone of the liver is first affected by viral hepatitis
periportal zone (zone 1)
yellow fever targets what zone in the liver?
Zone 2
what liver zone do you see the pericentral vein?
Zone 3
what zone is the most sensitive to metabolic toxins
Zone 3
what zone is the site for alcohol hepatitis
Zone 3
Gall stones that block the common bile duct and pancreatic duct at the ampulla of Vater causes what two pathologies?
Cholangitis and pancreatitis
what type of pathology is associated with the head of the pancreas that cause painless jaundice
Ductal adenocarcinoma (obstruct common bile duct)
which structure is not found in the femoral sheath
femoral n
Cremastic muscle and fascia comes from what inguinal canal structure?
Int oblique
Transversals Fascia becomes what part of spermatic cord?
internal spermatic fascia
External Oblique becomes
ext spermatic fascia
defect of pleuroperitoneal membrane refers to what disease?
diaphragmatic hernia
why does Diaphragmatic Hernia commonly occur on the left side?
due to the protection of the right Hemidiaphragm by the liver
Hour Glass stomach refers to?
sliding hiatal hernia
what is a complication of sliding hiatal hernia
GERD
what kind of cancer is associated with Barret Esophagus?
Adenocarcinoma
Fundus protruding into the thorax is seen in what pathology?
Paraesophageal Hernia
Occurs in infants due to failure of the processus Vaginialis
indirect hernia
what other pathology is associated with failure of process vaginalis
hydrocele
what type of hernia is more common in females
femoral hernia
what zone is affected by hemochromatosis
zone 1
Which regulatory substances decrease gastric acid secretion?
somatostatin, secretin, GIP
Which regulatory substance is produced by K cells?
GIP - glucose dep insulinotropic peptide
What is motilin’s mech of action?
produces migrating motor complexes
Fatty acids increase the release of which GI substances?
CCK, Secretin, GIP
Amino acids increase the release of which GI substances
gastrin, CCK, GIP
What hormone secreting tumor causes watery diarrhea, hypokalemia, achlorhydria?
VIP-oma
Loss of NO secretion is related to which GI issue?
Inc LES tone of achalasia
Where is VIP released from?
PNS ggl of sphincters, GB, and SI
Which hormone inc/dec GB contraction?
CCK/Somatostatin
Brunner glands of duod produce what?
HCO3-
Enterochromaffin cells release what that cause inc in gastric acid secretion?
Histamine
What stimulates enterochromaffin cells?
Gastrin
What distinguishes GI mucosal damage from other forms of malabsorption?
D-xylusose absorption test
What transporter is responsible for glucose and galactose uptake?
SGLT1
How is fructose uptake done?
facilitated diffusion
Where is Fe absorbed?
Absorbed as Fe2+ in duodenum
Folate is absorbed in ?
SI
M cells are located where? function?
in peyers patches; are antigen presenting cells
Which IG is secreted from Peyer’s patches?
IgA
rate limiting step of bile acid synthesis?
cholesterol 7 alpha hydroxylase
Which GI hormone is increased by chronic PPI use?
Gastrin
Octreotide is an analogue of what GI hormone, and is used to treat which pathologies?
Somatostatin, and used to treat acromegaly, carcinoid syndrome, and variceal bleeding
Which hormone is increased in Prader Willi syndrome?
Ghrelin (Inc appetite)
