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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 which germ layer?

A

Mesoderm

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8
Q

Dorsal/Ventral mesentery covers…

A

Dorsal: Most abdominal structures; Ventral: Exists at the bottom esophagus, stomach, and upper duodenum

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9
Q

The ventral mesentery is derived from?

A

Septum transversum (mesenchyme tissue)

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10
Q

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

A

Greater curvature of the stomach; Mesogastrium

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11
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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12
Q

The ‘lung bud’ comes off from what structure? What structure divides it from the esophagus?

A

Foregut; Tracheoesophageal septum divides diverticulum

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13
Q

Esophageal atresia develops due to…

A

Abnormal tracheoesophageal septum development; septum deviates posteriorly

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14
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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15
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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16
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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17
Q

What is the treatment/prognosis for esophageal atresia?

A

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

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18
Q

The midgut begins development during which week of gestation?

A

6th

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19
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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20
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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21
Q

Liver-containing omphalocele occurs when…

A

Lateral embryonic folds fail

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22
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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23
Q

What 3 genetic defects are associated with Omphalocele?

A

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

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24
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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25
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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26
Q

What is the treatment for Gastroschisis?

A

Surgical reduction/closure

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27
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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28
Q

What are the symptoms and treatment for Volvulus?

A

Symptoms: Vomiting, sepsis, Abdominal distension; Treatment: urgent surgery

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29
Q

What is the most common congenital GI abnormality?

A

Meckel’s Diverticulum

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30
Q

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

A

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

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31
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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32
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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33
Q

Meckel’s Diverticulum often contains what tissue?

A

‘Ectopic gastric tissue’, sometimes pancreatic tissue also

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34
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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35
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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36
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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37
Q

When do Meckel’s diverticulum commonly present?

A

In childhood

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38
Q

What is the treatment for Meckel’s diverticulum?

A

Surgery

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39
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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40
Q

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

A

Polyhydramnios, Bilious vomiting

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41
Q

Duodenal Atresia occurs probably due to failure of…

A

‘Recanalization’

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42
Q

Duodenal Atresia is associated with what condition?

A

Down syndrome

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43
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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44
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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45
Q

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

A

Curled → ‘Apple tree atresia’

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46
Q

Newborns with Pyloric stenosis will present with [2]

A

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

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47
Q

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

A

Males; 1st

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48
Q

Spleen arises from [tissue]

A

Dorsal mesodermal tissue of the stomach

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49
Q

What is the arterial supply for the spleen?

A

Celiac trunk

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50
Q

Gastrosplenic (gastrolienal) ligament carries which 2 vessels?

A

Short gastric arteries, left gastroepiploic vessels

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51
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)

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52
Q

What structures are intraperitoneal?

A

Stomach, appendix, liver, spleen, 1st part duodenum, jejunum, ileum, Colon (Transverse, sigmoid), Part of rectum, Tail of pancreas

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53
Q

Retroperitoneal bleeding often occurs as a complication of…

A

Surgical procedure (but many causes)

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54
Q

What are the borders of the greater sac?

A

Entire width of abdomen; Diaphragm to pelvic floor

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55
Q

Where is the lesser sac located?

A

Behind liver, stomach, lesser omentrum

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56
Q

Lesser sac is an [open/closed] space

A

Closed

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57
Q

What is the Epiploic foramen?

A

Opening between greater/lesser sac

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58
Q

What are 2 other names for the Epiploic foramen?

A

Omental foramen, Foramen of Winslow’s

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59
Q

Pectinate line (or Dentate line) is part of the…

A

Anal canal

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60
Q

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

A

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

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61
Q

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

A

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

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62
Q

What artery supplies the tissue above the pectinate line?

A

Superior rectal artery (branch of IMA)

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63
Q

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

A

Superior rectal vein → inferior mesenteric → portal system

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64
Q

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

A

Internal iliac nodes

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65
Q

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

A

Internal

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66
Q

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

A

Visceral (no pain)

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67
Q

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

A

Adenocarcinoma (rare form of anal cancer)

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68
Q

What artery supplies the tissue below the pectinate line?

A

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

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69
Q

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

A

Inferior rectal → internal pudendal → internal iliac → IVC

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70
Q

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

A

Superficial inguinal nodes

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71
Q

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

A

Somatic (painful)

72
Q

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

A

External

73
Q

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

A

Squamous cell carcinomas (more common anal CA)

74
Q

The anus is formed when the ____ and ____ meet

A

Hindgut and ectoderm

75
Q

Imperforate Anus is commonly associated with what 2 GU malformations?

A

Renal agenesis, Bladder exstrophy

76
Q

Imperforate Anus commonly presents clinically with [2]

A

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

77
Q

What structures does the celiac trunk supply?

A

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

78
Q

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

A

T12

79
Q

What are the 3 branches of the celiac trunk?

A

Left gastric (runs superiorly), Common hepatic, Splenic

80
Q

What artery(s) supply the lesser curvature?

A

Left and Right gastric

81
Q

What artery(s) supply the greater curvature?

A

Left and right Gastroepiploic

82
Q

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

A

Short gastric Artery (branch of splenic artery)

83
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

84
Q

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

A

Gastroduodenal artery

85
Q

Short gastric arteries are branches of the…

A

Splenic artery

86
Q

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

A

No dual blood supply

87
Q

Where is the Hepatoduodenal Ligament found?

A

On the ‘free border of lesser omentum’

88
Q

The Hepatoduodenal Ligament contains what 3 structures?

A

Proper hepatic artery (branch of common hepatic), Cystic duct, Portal vein

89
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

90
Q

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

A

IVC or hepatic veins

91
Q

What structures does the Superior Mesenteric artery supply?

A

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

92
Q

The Superior Mesenteric artery descends across the [2]

A

Pancreas head and duodenum

93
Q

What are arcades and vasa recta?

A

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

94
Q

What is SMA syndrome?

A

Rare cause of bowel obstruction where the distal duodenum is compressed between the aorta and SMA

95
Q

Patient with SMA syndrome classically presents with

A

Recent, massive weight loss

96
Q

What structures does the Inferior Mesenteric artery supply?

A

Last 1/3 transverse, descending, sigmoid colon

97
Q

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

A

Superior and inferior pancreaticoduodenal arteries (supply stomach)

98
Q

Gastric ischemia from vessel occlusion [common/rare]

A

Rare

99
Q

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

A

Marginal artery of Drummond (receives branches)

100
Q

What keeps SMA away from the duodenum?

A

The structures that keep SMA away from the duodenum are not specified.

101
Q

What is the classic presentation of a patient with SMA syndrome?

A

Recent, massive weight loss.

102
Q

What structures does the Inferior Mesenteric artery supply?

A

Last 1/3 of the transverse colon, descending colon, and sigmoid colon.

103
Q

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

A

Superior and inferior pancreaticoduodenal arteries.

104
Q

Is gastric ischemia from vessel occlusion common or rare?

A

Rare.

105
Q

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

A

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

106
Q

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

A

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

107
Q

Is rectal ischemia from occlusion common or rare?

A

Rare.

108
Q

Which intestine is most severely affected by mesenteric ischemia?

A

Small intestine.

109
Q

What is ischemic colitis?

A

Ischemia of the colon.

110
Q

What are four 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
111
Q

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

A

Check the heart for A-Fib.

112
Q

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

A

Jejunum (via SMA).

113
Q

What areas of the GI tract are usually affected by non-occlusive ischemia?

A

Watershed areas of the colon.

114
Q

What GI condition often results from non-occlusive ischemia?

A

Ischemic colitis.

115
Q

What are two symptoms seen in mesenteric ischemia and what is the onset?

A
  • Abdominal pain, cramping
  • Usually sudden onset.
116
Q

What are four common physical exam findings in mesenteric ischemia?

A
  • Usually mild tenderness
  • No rebound tenderness or peritoneal signs
  • Occult blood in stool.
117
Q

What labs are elevated in mesenteric ischemia?

A

WBC and lactate (acidosis).

118
Q

What are watershed areas?

A

Colon areas located between major vessels.

119
Q

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

A
  • Splenic Flexure
  • Rectosigmoid junction.
120
Q

Chronic mesenteric ischemia usually occurs in what demographic?

A

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

121
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.
122
Q

What are the four layers of the digestive tract?

A
  • Mucosa
  • Submucosa
  • Muscular layer
  • Serosa/adventitia.
123
Q

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

A
  • Epithelium
  • Lamina propria
  • Muscularis mucosa.
124
Q

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

A
  • Support
  • Gastric glands in the stomach.
125
Q

The submucosal layer in the GI tract consists of what two components?

A
  • Connective tissue
  • Meissner’s plexus (submucosal plexus).
126
Q

The muscular layer in the GI tract consists of what three components?

A
  • Inner circular smooth muscle
  • Auerbach’s plexus (between layers)
  • Outer longitudinal layer.
127
Q

What is abnormal in Achalasia?

A

Auerbach’s plexus.

128
Q

The serosa layer in the GI tract consists of a layer of what?

A
  • Surface epithelial cells (mesothelium)
  • Secretes lubricating fluid.
129
Q

Adventitia is found on what structures?

A

Retroperitoneal structures.

130
Q

Adventitia is made of what and how does it compare to serosa?

A
  • Loose connective tissue
  • Compared to serosa, it is not lubricated.
131
Q

What type of cells comprise the esophagus?

A

Non-keratinized stratified squamous epithelium.

132
Q

What type of cells comprise the stomach?

A

Simple columnar epithelium.

133
Q

What two features are unique to the gastric mucosa?

A
  • Gastric pits
  • Gastric glands (in lamina propria).
134
Q

What are four types of cells found in the gastric glands?

A
  • Parietal cells
  • Chief cells
  • Mucous neck cells
  • G cells.
135
Q

What three features are unique to the small intestinal mucosa?

A
  • Villi
  • Crypts (of Lieberkuhn)
  • Microvilli.
136
Q

Villi are extensions into the lumen from which layer?

A

Mucosa.

137
Q

What do crypts (of Lieberkuhn) contain?

A

Goblet cells.

138
Q

What are microvilli?

A

Microscopic extensions of the epithelial cell membrane.

139
Q

What are two other names for Plicae Circulares?

A
  • Kerckring folds
  • Valvulae conniventes.
140
Q

What layer(s) of the GI tract make up the Plicae Circulares?

A

Mucosa and submucosa.

141
Q

Plicae Circulares is most abundant in which part of the GI tract?

A

Jejunum.

142
Q

The greatest number of goblet cells is found in which part of the GI tract?

A

Ileum (increases in number from duodenum to ileum).

143
Q

In which parts of the GI tract are goblet cells normally found?

A

Small and large intestine.

144
Q

Where else can goblet cells be found in the setting of chronic inflammation?

A

In the stomach (gastritis) due to intestinal metaplasia.

145
Q

Where are Brunner’s glands found?

A

Submucosal layer of the duodenum.

146
Q

What do Brunner’s glands secrete?

A
  • Alkaline fluid that protects intestine from acidic stomach fluid and chyme.
147
Q

Brunner’s glands increase thickness in which disease?

A

Peptic ulcer disease.

148
Q

In what layer of the GI tract are lymph cells found?

A

Lamina propria.

149
Q

What is the distribution of lymph cells within the GI tract?

A

Increases from duodenum to ileum, then aggregates into Peyer’s patches.

150
Q

Where in the GI tract are Peyer’s patches found and in what layer?

A
  • Ileum
  • Right beneath the muscularis mucosa in the submucosa.
151
Q

What is the function of M cells?

A

Deliver antigens to the Peyer’s patches (acts as lymph node).

152
Q

What are lacteals and what is their function?

A
  • Lymphatic channels within villi
  • Important for absorption of fats.
153
Q

What does the colon produce a lot of?

A

Mucous.

154
Q

What is the main function of the colon?

A

Absorbs fluid and electrolytes.

155
Q

What are three distinguishing features of the colon?

A
  • Lots of goblet cells
  • Crypts without villi
  • Haustra.
156
Q

What are Haustra?

A

Pouches of the colon.

157
Q

What do erosions affect compared to ulcers in the GI tract?

A
  • Erosions: Mucosa only
  • Ulcers: Submucosa and muscularis mucosa.
158
Q

What does Meissner’s plexus control?

A

Secretion and blood flow.

159
Q

What is another name for Auerbach plexus?

A

Myenteric nerve plexus.

160
Q

What is the major role of the Auerbach plexus?

A

Control of GI motility.

161
Q

What are slow waves in the GI tract?

A

Oscillating membrane potential of GI smooth muscle.

162
Q

Where do slow waves in the GI tract originate?

A

Interstitial cells of Cajal (pacemaker cells).

163
Q

How do interstitial cells of Cajal initiate action potential?

A
  • Membrane potential ‘slowly’ rises near threshold
  • When near threshold, action potentials may occur.
164
Q

Slow waves set the maximum number of what per time in the GI tract?

A

Contractions.

165
Q

What is the slow wave frequency in the stomach, duodenum, and ileum?

A
  • Stomach: 3/min
  • Duodenum: 12/min
  • Ileum: 8/min.
166
Q

The Ampulla of Vater is where which two ducts merge?

A

Common bile duct and pancreatic duct.

167
Q

The Ampulla of Vater empties into which part of the GI tract?

A

Duodenum.

168
Q

The Ampulla of Vater is the anatomical transition from the foregut to what?

A

Midgut (celiac trunk transition to SMA).

169
Q

What structure is where bile and pancreatic enzymes enter the duodenum?

A

Major Duodenal Papilla.

170
Q

What structure surrounds the Major Duodenal Papilla?

A

Sphincter of Oddi.

171
Q

What is the Sphincter of Oddi and what is its function?

A
  • Circular smooth muscle layer that surrounds the Major Duodenal Papilla
  • Controls flow of bile and pancreatic enzymes into duodenum and prevents reflux.
172
Q

What is Sphincter of Oddi Dysfunction?

A

Narrowing of Sphincter of Oddi.

173
Q

Sphincter of Oddi Dysfunction can occur after what two conditions?

A
  • Pancreatitis
  • Gallstone disease.
174
Q

What are four common symptoms of Sphincter of Oddi Dysfunction?

A
  • RUQ pain
  • Possible abnormal LFT, hyperbilirubinemia
  • Recurrent pancreatitis.
175
Q

What are two potential therapies for Sphincter of Oddi Dysfunction?

A
  • Smooth muscle relaxant (Ca channel blocker, nitrates)
  • Endoscopic sphincterotomy.
176
Q

What may cause Sphincter of Oddi Spasm?

A

Opioids, i.e., morphine.

177
Q

What is the drug of choice for pain relief in a patient with pancreatitis?

A

Meperidine (Demerol).

First Aid (18 decks)

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