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First Aid > Gastroenterology 1 > Flashcards

Gastroenterology 1 Flashcards

1
Q

What parts of the GI tract are derived from endoderm?

A

GI tract epithelium, glands, and many organs that bud off: liver, pancreas, trachea.

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2
Q

What 4 parts of the GI tract are derived from mesoderm?

A

Connective tissue/strome, muscles, peritoneum, spleen.

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3
Q

The foregut forms which parts of the GI tract?

A

Celiac trunk, mouth to ampulla of Vater (including liver, gallbladder, bile ducts, pancreas).

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4
Q

The midgut forms which parts of the GI tract?

A

SMA, ampulla of Vater to transverse colon.

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5
Q

The hindgut forms which parts of the GI tract?

A

IMA, transverse colon to rectum.

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6
Q

What is mesentery?

A

Double layer of peritoneum that suspends abdominal organs from cavity walls.

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7
Q

What is the mesentery derived from?

A

Mesoderm.

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8
Q

Dorsal mesentery covers…

A

Most abdominal structures.

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9
Q

Ventral mesentery covers…

A

Exists at the bottom of the esophagus, stomach, and upper duodenum.

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10
Q

What does the liver grow into?

A

This mesentery forms the lesser omentum and falciform ligament.

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11
Q

The ventral mesentery is derived from?

A

Septum transversum (mesenchyme tissue).

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12
Q

The Greater omentum hangs from the _______ and is formed from the ________.

A

Greater curvature of the stomach, mesogastrium.

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13
Q

Where is the lesser omentum and what is it formed from?

A

Between the liver and stomach, formed from ventral mesentery.

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14
Q

The ‘lung bud’ comes off from what structure?

A

Foregut.

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15
Q

What structure divides the lung bud from the esophagus?

A

Tracheoesophageal septum.

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16
Q

Esophageal atresia develops due to…

A

Abnormal tracheoesophageal septum development; septum deviates posteriorly.

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17
Q

What are 3 clinical features of esophageal atresia?

A

Polyhydramnios (baby cannot swallow fluid), drooling, choking, vomiting (accumulation secretion), cannot pass NG tube into stomach.

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18
Q

Forms of Esophageal atresia?

A

EA with tracheoesophageal fistula (TEF): most common, pure EA, H-Type: esophagus and trachea connected by a fistula.

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19
Q

What are 2 clinical findings in a patient with tracheoesophageal fistula?

A

Gastric distension (air in stomach on CXR), reflux → aspiration pneumonia → respiratory distress.

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20
Q

What is the treatment/prognosis for esophageal atresia?

A

Treatment: Surgical repair. Prognosis: sometimes residual dysmotility, GERD.

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21
Q

The midgut begins development during which week of gestation?

A

6th.

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22
Q

Describe the development of the midgut.

A

Abdomen is too small so intestines herniate through umbilical cord (‘physiologic herniation’ visible on ultrasound!) → midgut rotates around SMA, continues to rotate after return to abdomen by 12th week → results in cecum in right lower quadrant.

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23
Q

What is an omphalocele? What are 2 key features?

A

Persistence of normal midgut herniation through the umbilicus during development (Normally does not contain liver). Key features: Covered by peritoneum, through umbilical cord.

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24
Q

Liver-containing omphalocele occurs when…

A

Lateral embryonic folds fail.

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25
Q

What is the clinical presentation of Omphalocele?

A

Normal GI function BUT associated with other conditions i.e. congenital heart defects (50%), neural tube defects.

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26
Q

What 3 genetic defects are associated with Omphalocele?

A

Trisomy 21 (Down syndrome), Trisomy 18 (Edwards syndrome), Trisomy 13.

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27
Q

What is Gastroschisis? What is a key characteristic?

A

Extrusion of bowel through abdominal wall due to paraumbilical abdominal wall defect (usually on right side). NOT covered by peritoneum.

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28
Q

What is the clinical presentation of Gastroschisis?

A

Poor GI function, often associated with atresia, stenosis. Few associated defects → good prognosis if GI function is restored.

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29
Q

What is the treatment for Gastroschisis?

A

Surgical reduction/closure.

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30
Q

What are 3 possible outcomes of midgut malrotation during development?

A

Obstruction: Cecum can end up in mid-upper abdomen → stretches peritoneum forming Ladd bands → duodenal obstruction. Volvulus: small bowel twists around SMA → Vascular compromise → ischemia → obstruction. Left sided colon: anatomic variant.

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31
Q

What are the symptoms and treatment for Volvulus?

A

Symptoms: Vomiting, sepsis, abdominal distension. Treatment: urgent surgery.

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32
Q

Omphalocele vs Gastroschisis

A

Omphalocele: covered by peritoneum, through umbilical cord. Gastroschisis: not covered by peritoneum, extrusion of bowel.

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33
Q

What is the most common congenital GI abnormality?

A

Meckel’s Diverticulum.

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34
Q

By week 5, the yolk sac begins to ____ and becomes the ____

A

Narrow, ‘Yolk stalk,’ ‘vitelline duct,’ ‘omphalomesenteric duct.’

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35
Q

Vitelline duct normally disappears by which week of gestation? Persistence can lead to what?

A

9th week. Persistence can lead to: Meckel’s diverticulum (most common), cysts/polyps, sinus: cavity behind umbilicus, intestinal discharge from umbilicus.

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36
Q

What is a Meckel’s Diverticulum?

A

Persistent remnant of vitelline duct, diverticulum of the ileum. Involves all layers of the small bowel (mucosa, submucosa, muscular) → ‘true diverticulum.’

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37
Q

Meckel’s Diverticulum often contains what tissue?

A

‘Ectopic gastric tissue’, sometimes pancreatic tissue also.

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38
Q

What are the symptoms of Meckel’s Diverticulum? What are 3 possible complications?

A

Usually no symptoms. Complications: Gastric tissue can secrete acid → ulceration, bleeding; obstruction; diverticulitis.

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39
Q

What is the Meckel’s Diverticulum ‘Rule of 2s’?

A

2 percent of population, male-to-female ratio 2:1, within 2 feet from ileocecal valve, usually 2 inches in size.

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40
Q

What are 2 ways to diagnose Meckel’s diverticulum?

A

Technetium scan: Tracer taken up by gastric cells in diverticulum. Capsule endoscopy.

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41
Q

When do Meckel’s diverticulum commonly present?

A

In childhood.

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42
Q

What is the treatment for Meckel’s diverticulum?

A

Surgery.

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43
Q

Where is the most common and least common site of atresia/stenosis in the GI tract?

A

Most common: duodenum. Least common: colon.

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44
Q

What are 2 common symptoms seen in GI atresia and stenosis at birth?

A

Polyhydramnios, bilious vomiting.

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45
Q

Duodenal Atresia occurs probably due to failure of…

A

‘Recanalization.’

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46
Q

Duodenal Atresia is associated with what condition?

A

Down syndrome.

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47
Q

What sign on imaging is seen with Duodenal Atresia?

A

Double bubble sign (Distention of duodenum stump and stomach with tight pylorus in middle).

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48
Q

What is the mechanism of Jejunal-Ileal-Colonic Atresia?

A

Vascular disruption → ischemic necrosis of intestine → necrotic tissue is reabsorbed and leaves blind ends of bowel.

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49
Q

In Jejunal-Ileal-Colonic Atresia, the bowel distal to the blind end may be…

A

Curled → ‘Apple tree atresia.’

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50
Q

Newborns with Pyloric stenosis will present with [2]

A

‘Projectile,’ non-bilious vomiting; palpable mass (Feels like ‘olive’).

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51
Q

Pyloric stenosis is more common in [M/F]. 30% are [1st/2nd] born children.

A

Males, 1st.

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52
Q

Spleen arises from what tissue?

A

Dorsal mesodermal tissue of the stomach.

53
Q

What is the arterial supply for the spleen?

A

Celiac trunk.

54
Q

Gastrosplenic (gastrolienal) ligament carries which 2 vessels?

A

Short gastric arteries, left gastroepiploic vessels.

55
Q

What structures are retroperitoneal?

A

SAD PUCKER: Suprarenal (adrenal glands), Aorta + IVC, Duodenum (2nd and 3rd segments), Pancreas (except tail), Ureters, Colon (ascending and descending), Kidneys, Esophagus, Rectum (partly).

56
Q

What structures are intraperitoneal?

A

Stomach, appendix, liver, spleen, 1st part duodenum, jejunum, ileum, colon (transverse, sigmoid), part of rectum, tail of pancreas.

57
Q

Retroperitoneal bleeding often occurs as a complication of…

A

Surgical procedure (but many causes).

58
Q

What are the borders of the greater sac?

A

Entire width of abdomen, diaphragm to pelvic floor.

59
Q

Where is the lesser sac located?

A

Behind liver, stomach, lesser omentrum.

60
Q

Lesser sac is an [open/closed] space.

A

Closed.

61
Q

What is the Epiploic foramen?

A

Opening between greater/lesser sac.

62
Q

What are 2 other names for the Epiploic foramen?

A

Omental foramen, foramen of Winslow’s.

63
Q

Pectinate line (or Dentate line) is part of the anal canal.

A

True.

64
Q

What tissue above the pectinate line is derived from? Tissue below?

A

Tissue above: hindgut. Tissue below: proctodeum (ectoderm).

65
Q

The tissue above the pectinate line is composed of what type of epithelium?

A

Above: columnar (similar to digestive tract). Below: stratified squamous epithelium (similar to skin).

66
Q

What artery supplies the tissue above the pectinate line?

A

Superior rectal artery (branch of IMA).

67
Q

What is the venous drainage for the tissue above the pectinate line?

A

Superior rectal vein → inferior mesenteric → portal system.

68
Q

What is the lymphatic drainage for the tissue above the pectinate line?

A

Internal iliac nodes.

69
Q

Veins above the pectinate line can form [internal/external] hemorrhoids?

A

Internal.

70
Q

Tissue above the Pectinate line receives [somatic/visceral] innervation.

A

Visceral (no pain).

71
Q

Tissue above the Pectinate line is associated with what type of cancer?

A

Adenocarcinoma (rare form of anal cancer).

72
Q

What artery supplies the tissue below the pectinate line?

A

Inferior rectal artery (Branch of internal pudendal artery, off iliac).

73
Q

What is the venous drainage for the tissue below the pectinate line?

A

Inferior rectal → internal pudendal → internal iliac → IVC.

74
Q

What is the lymphatic drainage for the tissue below the pectinate line?

A

Superficial inguinal nodes.

75
Q

Tissue below the Pectinate line receives [somatic/visceral] innervation.

A

Somatic (painful).

76
Q

Veins below the pectinate line can produce [internal/external] hemorrhoids?

A

External.

77
Q

Tissue below the Pectinate line is associated with what type of cancer?

A

Squamous cell carcinomas (more common anal CA).

78
Q

The anus is formed when the ____ and ____ meet.

A

Hindgut and ectoderm.

79
Q

Imperforate Anus is commonly associated with what 2 GU malformations?

A

Renal agenesis, bladder exstrophy.

80
Q

Imperforate Anus commonly presents clinically with [2]

A

Failure to pass meconium, meconium from urethra or vagina (fistula).

81
Q

What structures does the celiac trunk supply?

A

Foregut structures (stomach, spleen, liver, gallbladder, part of duodenum, pancreas).

82
Q

At what vertebral level does the celiac trunk come off the aorta?

A

T12.

83
Q

What are the 3 branches of the celiac trunk?

A

Left gastric (runs superiorly), common hepatic, splenic.

84
Q

What artery(s) supply the lesser curvature?

A

Left and right gastric.

85
Q

What artery(s) supply the greater curvature?

A

Left and right Gastroepiploic.

86
Q

What artery(s) supplies the cardia/fundus of the stomach?

A

Short gastric artery (branch of splenic artery).

87
Q

Gastric ulcers are more common in the [lesser/greater] curvature. Ulcers that ruptured would cause bleeding from the [artery].

A

Lesser, left gastric artery.

88
Q

Posterior duodenal ulcers that ruptured would cause bleeding from the [artery].

A

Gastroduodenal artery.

89
Q

Short gastric arteries are branches of the…

A

Splenic artery.

90
Q

Why are short gastric arteries vulnerable to ischemia if splenic artery is occluded?

A

No dual blood supply.

91
Q

Where is the Hepatoduodenal Ligament found?

A

On the ‘free border of lesser omentum.’

92
Q

The Hepatoduodenal Ligament contains what 3 structures?

A

Proper hepatic artery (branch of common hepatic), cystic duct, portal vein.

93
Q

What is the Pringle’s maneuver? What is it used for?

A

Clamping of hepatoduodenal ligament. Enables surgeons to halt hemorrhage and find the source of bleeding.

94
Q

If bleeding continues after the Pringle’s maneuver, which [2] vessels are most likely the cause of bleeding?

A

IVC or hepatic veins.

95
Q

What structures does the Superior Mesenteric artery supply?

A

Distal duodenum to the first 2/3 of transverse colon + appendix.

96
Q

The Superior Mesenteric artery descends across the [2]

A

Pancreas head and duodenum.

97
Q

What are arcades and vasa recta?

A

Arcades: Anastamoses of ileal/jejunal arteries. Vasa recta: Arteries extending from arcades.

98
Q

What is SMA syndrome?

A

Rare cause of bowel obstruction where the distal duodenum is compressed between the aorta and SMA (Mesenteric fat normally keeps SMA away from duodenum).

99
Q

Patient with SMA syndrome classically presents with…

A

Recent, massive weight loss.

100
Q

What structures does the Inferior Mesenteric artery supply?

A

Last 1/3 transverse, descending, sigmoid colon.

101
Q

What arteries serve as an abdominal collateral between the Celiac trunk and SMA?

A

Superior and inferior pancreaticoduodenal arteries (supply stomach).

102
Q

Gastric ischemia from vessel occlusion is [common/rare].

A

Rare.

103
Q

What arteries serve as an abdominal collateral between the SMA and IMA?

A

Marginal artery of Drummond (receives branches from middle (SMA) and left (IMA) colic arteries).

104
Q

What arteries serve as an abdominal collateral between the IMA and Iliac artery?

A

Superior rectal (IMA) merges with middle rectal (iliac).

105
Q

Rectal ischemia from occlusion is [common/rare].

A

Rare.

106
Q

Mesenteric ischemia of the [small/large] intestine is most severe.

A

Small.

107
Q

What is the collateral between the SMA and IMA?

A

Marginal artery of Drummond (receives branches from middle (SMA) and left (IMA) colic arteries)

108
Q

What arteries serve as an abdominal collateral between the IMA and Iliac artery?

A

Superior rectal (IMA) merges with middle rectal (iliac)

Occurs in rectum

109
Q

Is rectal ischemia from occlusion common or rare?

A

Rare

110
Q

Mesenteric ischemia of the small or large intestine is most severe?

A

Small (often life-threatening)

111
Q

What is ischemic colitis?

A

Ischemia of the colon

112
Q

What are 4 possible causes of Mesenteric ischemia?

A
  • Embolism: often cardiac origin (LV thrombus or LA thrombus due to AFib)
  • Arterial thrombosis: usually at site of atherosclerosis
  • Venous thrombosis: resistance to flow out of mesentery, one of the least common causes
  • Non-occlusive ischemia: hypoperfusion/shock
113
Q

If a patient presents with abdominal pain from ischemic colitis, what should you check next?

A

Check the heart for A-Fib

114
Q

In Mesenteric ischemia, what region of the intestine is most commonly affected by embolism?

A

Jejunum (via SMA)

115
Q

Non-occlusive ischemia usually affects what areas of the GI tract?

A

Watershed areas of colon

116
Q

Non-occlusive ischemia often results in what GI condition?

A

Ischemic colitis

117
Q

What are 2 symptoms seen in Mesenteric ischemia? What is the onset?

A
  • Abdominal pain, cramping
  • Usually sudden onset
118
Q

What 4 physical exam findings are common in Mesenteric ischemia?

A
  • “Pain out of proportion to exam”
  • Usually mild tenderness
  • No rebound tenderness or peritoneal signs
  • Occult blood in stool
119
Q

What labs are elevated in Mesenteric ischemia?

A

WBC and lactate (acidosis)

120
Q

What are watershed areas?

A

Colon areas located between major vessels

121
Q

What 2 GI structures are at the highest risk for ischemia in shock/hypoperfusion?

A
  • Splenic Flexure
  • Rectosigmoid junction
122
Q

Chronic mesenteric ischemia usually occurs in what demographic?

A

Older patient with other vascular disease (PAD risk factors are common)

123
Q

How does a patient with Chronic mesenteric ischemia present?

A
  • Recurrent abdominal pain after eating
  • Fear of eating → weight loss
  • Sudden worsening may suggest acute thrombosis
124
Q

What are the 4 layers of the digestive tract?

A
  • Mucosa
  • Submucosa
  • Muscular layer
  • Serosa/adventitia
125
Q

What 3 components make up the mucosal layer in the GI tract?

A
  • Epithelium
  • Lamina propria
  • Muscularis mucosa
126
Q

What is the function of the lamina propria and what is found here?

A
  • Support
  • Gastric glands in the stomach
127
Q

The submucosal layer in the GI tract consists of what?

A
  • Connective tissue
  • Meissner’s plexus (submucosal plexus)
128
Q

The muscular layer in the GI tract consists of what?

A
  • Inner circular smooth muscle
  • Auerbach’s plexus (between layers)
  • Outer longitudinal layer
129
Q

What is abnormal in Achalasia?

A

Auerbach’s plexus

First Aid (18 decks)

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