GASTROINTESTINAL Flashcards
The foregut extends from the ….. to the ….. at the level of ….. and ….. ?
The foregut extends from the oesophagus to the duodenum at the level of the pancreatic duct and common bile duct insertion (Ampulla of Vater)
The midgut extends from the …. …. to the ….. …. of the …. …..
The midgut extends from the lower duodenum to the proximal 2/3rds of the transverse colon
The hindgut extends from the ….. …. of the …. … to the … …. …. …. …
The hindgut extends from the distal 1/3rd of the transverse colon to the anal canal above the pectinate line
Name a ventral wall defect due to:
1) Rostral fold closure
2) Lateral fold closure (x2)
3) Caudal fold closure
1) Ectopia cordis
2) Gastroschisis, Omphalocoele
3) Bladder exstrophy
Describe the location of the herniation of abdominal wall contents in:
1) Gastroschisis?
2) Omphalocele?
1) Gastroschisis - paraumbilical herniation of the abdominal wall contents through abdominal wall defect
2) Herniation of abdominal wall contents through the umbilicus
Between gastroschisis and omphalocoele, which is covered by peritoneum and amnion and which isn’t?
Gastroschisis - covered by peritoneum and amnion VS
Omphalocele - uncovered by either peritoneum or amnion
Gastroschisis has good or bad prognosis?
Good prognosis (since not associated with chromosomal abnormalities)
Is omphalocoele associated with chromosomal abnormalities?
Yes
Which chromosomal abnormalities are associated with Omphalocoele?
Trisomies 13 and 18
Beckwith-Wiedemann syndrome
Why do congenital umbilical hernias happen embryologically speaking?
Due to failure of the umbilical ring to close after physiologic herniation of midgut, covered by skin
Give 2 associations with congenital umbilical hernias |(2 other conditions)
- Down’s syndrome
- Congenital hypothyroidism
List 3 different types of tracheosophageal anomalies
(Also which is most common?)
- Pure oesophageal atresia
- Pure tracheo-oesophageal fistula (H-type)
- Oesophageal atresia with tracheo-oesophageal fistula (Most common)
How will each type of oesophageal anomaly make the stomach look on CXR?
- Pure oesophageal atresia (gasless stomach)
- Pure tracheo-oesophageal fistula (prominent gastric bubble)
- Oesophageal atresia with distal TEF (prominent gastric bubble)
Note in normal anatomy there is a small gastric bubble on CXR
What is a useful clinical test indicative of oesophageal atresia with tracheo-oesophageal fistula?
Failure to pass an NG into the stomach
CXR sign in duodenal atresia?
“Double bubble sign”
Outline the arterial supply to the foregut, midgut and hindgut
Abdominal aorta —- coeliac axis then SMA then IMA
Coeliac axis supplies the foregut, SMA supplies the midgut, IMA supplies the hindgut
What CXR sign is shown in jejunal and ileal atresia?
Triple bubble sign
Duodenal atresia is associated with which other condition?
Down’s syndrome
Jejunal and ileal atresia is associated with which 2 other conditions?
Cystic fibrosis
Gastroschisis
Jejunal and ileal atresia may be caused by what maternal behaviours during pregnancy?
Tobacco smoking
Cocaine use (vasoconstrictive effect)
Hypertrophic pyloric stenosis presents with what electrolyte / acid-base disturbance?
Hypokalaemic, hyperchloraemic metabolic alkalosis
Hypertrophic pyloric stenosis more common in F or M?
M (often firstborn males)
What imaging investigation can be used to identify hypertrophic pyloric stenosis and what would it find?
U/s - thickened and lengthened pylorus
What is the management of hypertrophic pyloric stenosis?
Pyloromyotomy (surgical incision of pyloric muscles)
Hypertrophic pyloric stenosis is associated with exposure to which drug?
Macrolide
Pancreas is derived from foregut, midgut or hindgut?
Pancreas is derived from the foregut
Embryologically with regards the pancreas, the …. ….. … contributes to the uncinate process. Both … and … … contribute to …. … and main …. ……
Embryologically with regards the pancreas, the ventral bud contributes to the uncinate process. Both the ventral and dorsal buds contribute to the pancreatic head and the main pancreatic duct
How does annular pancreas occur, and how does it present?
Name another condition it is associated with
The ventral bud rotates abnormally forming a ring of pancreatic tissue which encircles the 2nd part of the duodenum which causes duodenal narrowing - presenting as vomiting
Associated with Down’s syndrome
How does pancreas divisum present embryologically and how might it present?
Failure of ventral and dorsal buds of pancreas to fuse at 7 weeks of development
Mostly asymptomatic, but may cause chronic abdominal pain and / or pancreatitis
Describe the arterial supply of the pancreas
Abdominal aorta - coeliac trunk - splenic artery
List the retroperitoneal structures
SADPUCKER
Suprarenal (adrenal glands)
Aorta and IVC
Duodenum (D2-D4)
Pancreas (except tail)
Ureters
Colon (descending and ascending)
Kidneys
E (oesophagus)
Rectum (partially)
Pg 368 labelling of GI ligaments
See page 368
What structure(s) are contained within the falciform ligament?
Ligamentum teres hepatis (derivative of foetal umbilical vein), patent paraumbilical veins
What structure(s) are contained within the hepatoduodenal ligament?
Portal triad: proper hepatic artery, portal vein, common bile duct
What structure(s) are contained within the hepatogastric ligament?
Gastric vessels
What structure(s) are contained within the gastrocolic ligament?
Gastroepiploic arteries
What structure(s) are contained within the gastrosplenic ligament?
Short gastrics, left gastroepiploic vessels
What structure(s) are contained within the splenorenal ligament?
Splenic artery and vein, tail of pancreas
Out of the following GI ligaments match them to whether they are ventral or dorsal mesentery derivatives:
1. Hepatoduodenal ligament
2. Hepatogastric ligament
3. Gastrocolic ligament
4. Gastrosplenic ligament
5. Splenorenal ligament
6. Falciform ligament
- Hepatoduodenal ligament - ventral mesentery
- Hepatogastric ligament - ventral mesentery
- Gastrocolic ligament - dorsal mesentery
- Gastrosplenic ligament - dorsal mesentery
- Splenorenal ligament - dorsal mesentery
- Falciform ligament - ventral mesentery
