GASTROINTESTINAL- Anatomy Flashcards
1
Q
Restroperitoneal structures
A
SAD PUCKER Suprarenal glands Aorta and IVC Duodenum (2nd through 4th parths) Pancreas (excepts tail) Ureters Colon (descending and ascending) Kidneys Esophagus (lower 2/3) Rectum (partially)
2
Q
Which is the main characteristics of retroperitoneal structures?
A
Include GI structures that lack mesentery and non GI structures
3
Q
What could be the results of injuries to retroperitoneal structures?
A
Can cause blood or gas accumulation in retroperitoneal space
4
Q
Important GI ligaments
A
Falciform Hepatoduodenal Gastrohepatic Gastrocolic Gastrosplenic Splenorenal
5
Q
What do falciform ligament connects?
A
Liver to anterior abdominal wall
6
Q
Structure contained in Falciform Ligament?
A
Ligamentum teres hepatis
7
Q
From where does the Ligamentum teres hepatis derived from?
A
Fetal umbilical vein
8
Q
From which structure does Falciform ligament derives from?
A
Ventral mesentery
9
Q
Ligament that connects Liver to duodenum
A
Hepatoduodenal ligament
10
Q
What structures are contained in Hepatoduodenal ligament?
A
Portal triad: proper hepatic artery, portal vein, common bile duct
11
Q
What is Pringle maneuver?
A
Ligament may be compressed between thumb and index finger placed in omental foramen to control bleeding
12
Q
Which structures are border by Hepatoduodenal ligament?
A
Border Omental foramen, which connects the greater and lesser sacs
13
Q
Structures connected by Gastrohepatic ligament
A
Liver to lesser curvature of stomach
14
Q
Where does Gastrohepatic ligament is contained?
A
Within lesser omentum
15
Q
In which structure are Gastric arteries contained?
A
Gastrohepatic ligament
16
Q
What does Gastrohepatic ligament separates?
A
Separates greater and lesser sacs on the right
17
Q
What structure may be cut during surgery to access lesser sac?
A
Gastrohepatic ligament
18
Q
Separates greater and lesser sacs on the right
A
Gastrohepatic ligament
19
Q
This ligament goes from greater curvature of stomach to Transverse colon
A
Gastrocolic
20
Q
Structures contained in Gastrocolic ligament
A
Gastroepiploic arteries
21
Q
Part of greater omentum
A
Gastrocolic ligament
22
Q
Structures connected by Gastrosplenic ligament
A
Greater curvature and spleen
23
Q
Which structures are contained in gastrosplenic ligament?
A
Short gastrics, left gastroepiploic vessels
24
Q
Structures separeted by Gastrosplenic ligament
A
Separates greater and lesser sacs on the left
25
Separates greater and lesser sacs on the left
Gastrosplenic ligament
26
Ligament that connects Spleen to posterior abdominal wall
Splenorenal
27
What structures are contained in Splenorenal ligaments?
Splenic artery and vein, tail of pancreas
28
Layers of gut wall (inside to outside)
MUcosa
Submucosa
Muscularis externa
Serosa
29
Structures contained in Mucosa
```
Epithelium (absorption)
Lamina propria (support)
Muscularis mucosa (motility)
```
30
Which important structure is contained in Submucosa?
Includes subumucosal nerve plexus (Meissner)
31
Which important structure is contained in Submucosa?
Includes subumucosal nerve plexus (Meissner)
32
Structures included in Muscularis Externa
Includes Myenteric nerve plexus (Auerbach)
33
Characteristic that differentiate Serosa and Adventitia
Serosa (When intraperitoneal)
| Adventitia (when retroperitoneal)
34
How much can ulcers extend?
Into submucosa, inner or outter muscular layer
35
Where are erosins found in the layers of gut wall?
In the mucosa only
36
How is the frequency of basal electric rhythm in Stomach?
3 waves/ min
37
Frequency of basal electric rhythm in Duodenum
12 waves/min
38
How are the frequency of basal electric rhythm Ileum?
8-9 waves/min
39
What is the mesothelium?
Protective coating; reduction of friction
40
What is the function of Mesentery?
Binding of digestive tract to abdominal wall
41
Where are the glands that manage the secretion in GI tract?
In submucosal layer
42
Who controls muscle contractions in GI tract?
Myenteric plexus
43
Who manages motility in GI tract?
Inner circular layer
| Outer longitudinal muscle layer
44
Where is the control of secretory activity of the GI tract?
Submucosal plexus
45
Manages mucosal motility
Muscularis mucosae
46
Function of Serosa
Suport
47
Epithelium found in esophagus
Nonkeratinized stratified squamous epithelium
48
Hystologic characteristic of Stomach
Gastric glands
49
Hystologic characteristics of Duodenum
Villi and microvilli ↑ absorptive surface
| Brunner glands and crypts of Lieberkuhn
50
Where are Brunner glands found?
Submucosa of Duodenum
51
What hystologic characteristics does Jejunum has?
Plicae circulares and crypts of Lieberkuhn
52
Unique hystologic characteristics of Ileum
Peyer patches
Largest number of Goblet cells in the small intestine
Plicae circulares and crypts of Lieberkuhn (common to Jejunum)
53
Where are Peyer patches found?
Lamina propia, submucosa of Ileum
54
Where in Ileum can plicae ciculares be found?
Proximal Ileum
55
characteristics of Colon hystology
Has crypts of Lieberkuhn but no villi; numerpus goblet cells
56
How do you identify the branches that supply GI structures from arteries supplynon non GI structures?
Arteries Supplying GI structures branch anteriorly
| Arteries supplying non GI structures branch laterally
57
What is the superior mesenteric artery syndrome?
When the transverse portion (third segment) of duodenum is entrapped between SMA and aorta, causing intestinal obstruction
58
Where can we identify the bifurcation of Abdominal aorta?
L4
59
Where is Celiac trunk?
T12
60
Where is Superior mesenteric Artery?
L1
61
Where is Inferior mesenteric artery?
L3
62
From whom is Median sacral artery a branch?
From the point of bifurcation of abdominal aorta
63
From which structure does Celiac artery comes from?
Foregut
64
Who gives parasympathetic innervation to celiac artery?
Vagus
65
Vertebral level where celiac artery is?
T12-L1
66
Structures supplied by Celiac artery
Pharynx to proximal duodenum; liver, gallbladerm pancreas, spleen (mesodem)
67
Embryonic gut region that forms Superior Mesenteric Artery
Midgut
68
Who gives innervation to Superior mesenteric artery?
Parasympathetic inervation of Vagus
69
Vertebral level where Superior mesenteric artery is found
L1
70
Artery that irrigates distal duodenum to proximal 2/3 of transverse colon
Superior mesenteric artery
71
Embryonic structure that gives place to Inferior mesenteric artery
Hindgut
72
Who gives parasympathetic innervation to Inferior mesenteric artery?
parasympathetic innervation of Pelvic
73
Vertebral level where Inferior mesenteric artery is found
L3
74
Structures supplied by Inferior mesenteric artery
Distal 1/3 of transverse colon to upper portion of rectum; splenic flexure is a watershed region
75
Branches of celiac trunk
Common hepatic
Slenic
Left gastric
76
Who constitutes the main blood supply of the stomach?
Celiac trunk
77
What happens if splenic artery is blocked?
Short gastric will have poor anastomoses
78
Which are the strong anastomoses in Stomach?
Left and right gastroepiploics
| Left and right gastrics
79
From whom is Gastroduodenal artery a branch?
Common hepatic artery
80
Main branches of Gastroduodenal artery
Anterior Superior pancreaticoduodenal artery
Posterior Superior pancreaticoduodenal artery
Right gastroepiploic artery
81
From whom is esophageal branch of?
Left gastric artery
82
Main branches of Common hepatic artery
Hepatic artery proper
Gastroduodenal artery
Right gastric artery
83
Branches of Splenic artery
Left gastroepiploicartery
| Short gastric arteries
84
When Superior epigastric (internal thoracic/ mamary) is blocked, which anastomose compensate?
Inferior epigastric (external iliac) and viceversa
85
When Superior pancreaticoduodenal (celiac trunk) is blocked, which anastomose compensate?
Inferior pancreaticoduodenal (SMA)
86
When Middle colic (SMA) is blocked, which anastomose compensate?
Left colic (IMA)
87
When superior rectal (IMA) is blocked, which anastomose compensate?
Middle and inferior rectal (internal iliac)
88
When superior rectal (IMA) is blocked, which anastomose compensate?
Middle and inferior rectal (internal iliac)
89
Name portosystemic anastomoses
Esophagus
Umbilicus
Rectum
90
Clinical sign of patologic blood flow in portal HTN directed to esophagus
Esophageal varices
91
Which veins have anastomosis with esophageal that cause esophageal varices during portal HTN?
Left gastric ↔ Esophageal
92
Clinical sign of patologic blood flow in portal HTN directed to umbilicus
Caput medusae
93
Which veins have anastomosis with paraumbilical that cause caput meduasae during portal HTN?
Parumbilical ↔ Small epigastric veins of the anterior abdominal wall
94
Clinical sign of patologic blood flow in portal HTN directed to Rectum
Anorectal varices (not internal hemorroids)
95
Which veins have anastomosis with superior rectal that cause anorectal varices during portal HTN?
Superior Rectal ↔ middle and inferior rectal
96
Which veins are commonly seen in portal hypertension?
Gut, butt and caput
97
Which is the surgical treatment for portal HTN?
Transjugular intrahepatic portosystemic shunt (TIPS)
98
How does TIPs work?
Between the portal and hepatic vein percutaneously relieves portal hypertension by shunting blood to the systemic circulation
99
Where is Pectinate line?
Formed where endoderm (hindgut) meets ectoderm
100
What forms Pectinate line?
Formed where endoderm (hindgut) meets ectoderm
101
Alternative name for Pectinate line
Dentate line
102
Alternative name for Pectinate line
Dentate line
103
Diseases that could appear above pectinate line
Internal hemorrhoids
| Adenocarcinoma
104
Who gives tha arterial supply above pectinate line?
Superior rectal artery
105
From whom is superior rectal artery a branch?
IMA
106
How is the drainage of structures above the pectinate line?
Superior rectal vein → Inferior mesenteric vein → portal system
107
Which hemorhoids are painful?
External hemorrhoids
108
Why internal hemorrhoids aren't painful?
Receive visceral innervation and are therefore no painful
109
Who gives the lymphatic drainage to structures above pectinante line?
Deep nodes
110
Diseases found below pectinate line
External hemorrhoids
Anal fissures
Squamous cell carcinoma
111
Who gives arterial supply below pectinate line?
Inferior rectal artery (branch of internal pudendal artery)
112
Who gives the venous drainage below pectinate line?
Inferior rectal vein → Internal pudendal vein → IVC
113
Who gives the venous drainage below pectinate line?
Inferior rectal vein → Internal pudendal vein → IVC
114
Why external hemorrhoids are painful?
Receive somatic innervation (inferior rectal branch of pudendal nerve)
115
Lymphatic drainage for below pectinate line
Superficial inguinal nodes
116
What does Apical surface of hepatocytes faces?
Faces bile canaliculi
117
What does Basolateral surface of hepatocytes faces?
Sinusoids
118
Where is Zone 1 of hepatocytes?
periportal zone
119
Which hepetic zone is affected first by viral hepatitis?
Zone I
120
Ingested toxins like cocaine affect first this hepatic zone
Zone I
121
Name for Hepatocytes zone II
Intermediate zone
122
Where is Hepatic zone III?
Pericentral vein (centrilobulillar) zone
123
Which is the first hepatic zone affected by ischemia?
Zone III
124
Which hepatic zone contains cytocrome P450 system?
Zone III
125
Hepatic zone most sensitive to metabolic toxins
Zone III
126
Which hepatic zone is the site for alcoholic hepatitis?
Zone III
127
How is the flow for central hepatic vein?
To hepatic veins and systemic circulation
128
Which hepatic structure manages lymphatic drainage?
Space of Disse
129
Liver Macrophages
Kupffer cell
130
How is microscopic blood flow in Liver?
From zone I to III
| Portal triad to Central vein
131
How is microscopic bile flow in liver?
From zone III to I
| Central vein to Portal triad
132
Portal triad
Bile duct
Branch of portal vein
Branch of hepatic artery
133
Which risk do gallstones can cause when reach the common channel?
Reach ampulla of Vater and can block both the bilr and pancreatic ducts
134
Risk of tummors that arise in the head of pancreas (near the duodenum)
Can cause obstruction of the common bile duct
135
How is the vessel organization in femoral region
Lateral to medial: NAVEL
| Nerve- Artery-Vein-Empty space Lymphatics
136
What does femoral triangle contains?
Femoral vein, artery, nerve
137
What is Femoral sheath and where is located?
Fascial tube 3-4 cm below inguinal ligament
138
What does Femoral sheath contains?
Vein, artery and canal (deep inguinal lymph nodes) but not femoral nerve
139
What is a Hernia?
A protrusion of peritoneum through an opening, ussually a site of weakness
140
What happens during diaphragmatic hernia?
Abdominal structures enter the thorax
141
Which is a cause of diaphragmatic hernia in infants?
Result of defective development of pleuroperitoneal membrane
142
Most common diaphragmatic hernia
Sliding hiatal hernia
143
What happens in diaphragmatic hernia?
Stomach herniates upward through the esophageal hiatus of the diaphragm
144
What happens in diaphragmatic hernia?
Stomach herniates upward through the esophageal hiatus of the diaphragm
145
What happens in Slidding hiatal hernia?
Gastroesophageal junction is displaced ↑
146
How is sliding hiatal hernia seen?
"Hourglass stomach"
147
Characteristics of Paraesophageal hernia
gastroesophageal junction is normal
| Fundus protrudes into thorax
148
What happens in indirect inguinal hernia?
Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring and into the scrotum
Enters internal inguinal ring lateral to inferior epigastric artery
149
When does indirect inguinal hernia occurs?
Occurs in infants owing to failure of processus vaginalis to close
150
What can a male infant patient form when having a indirect inguinal hernia?
Hydrocele
151
In whom is more common tje indirect inguinal hernia?
Much more common Male patients
152
Main characteristic of Indirect inguinal hernia
Follows the path of descent of the testes
| Covered by all 3 layers of spermatic fascia
153
Protrudes through the inguinal triangle
Direct inguinal hernia
154
Inguinal triangle
Hesselbach
155
Protrudes through Hesselbach triangle
Direct inguinal hernia
156
Characteristic of Direct inguinal hernia
Bulges directly through abdominal wall medial to inferior epigastric artery
157
Which is the way of direct inguinal hernia?
Goes through the external (superficial) inguinal ring only
158
Who covers the direct inguinal hernia?
External spermatic fascia
159
In which patients is more common to see direct inguinal hernia?
Ussualy in older patients
160
Medial to inferior epigastric artery
Direct hernia
161
Lateral to inferior epigastric artery
Indirect hernia
162
What happens in Femoral hernia?
Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle
163
In whom is more common to see Femoral hernia?
In females
164
Leading cause of bowel incarceration
Femoral hernia
165
Which structures form the Hesselbach triangle?
Inferior epigastric vessels
Lateral border of rectus abdominis
Inguinal ligament
