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USMLE 1 > Gastrointestinal- anatomy > Flashcards

Gastrointestinal- anatomy Flashcards

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USMLE® Step 1 flashcards
1
Q

Retroperitoneal structures

A 
SAD PUCKER:
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (2nd through 4th parts)
Pancreas (except tail)
Ureters
Colon (descending and ascending)
Kidneys
Esophagus (thoracic portion)
Rectum (partially)
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2
Q

Important gastrointestinal ligaments

A

Pag. 355

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3
Q

Layers of gut wall

A

MSMS:
ƒƒMucosa—epithelium, lamina propria, muscularis mucosa
ƒƒ Submucosa—includes Submucosal nerve plexus (Meissner), Secretes fluid
ƒƒMuscularis externa—includes Myenteric nerve plexus (Auerbach), Motility
ƒƒ Serosa (when intraperitoneal), adventitia (when retroperitoneal)

*Ulcers can extend into submucosa, inner or outer muscular layer. Erosions are in the mucosa only.

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4
Q

Frequencies of basal electric rhythm (slow waves):

A

ƒƒ Stomach—3 waves/min
ƒƒDuodenum—12 waves/min
ƒƒ Ileum—8–9 waves/min

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5
Q

Digestive tract histology

  • Esophagus
  • Stomach
  • Duodenum
A

Nonkeratinized stratified squamous epithelium.

Gastric glands

Villi and microvilli  absorptive surface. Brunner glands (HCO3− secreting cells of submucosa) and crypts of Lieberkühn (contain stem cells that replace enterocytes/goblet cells and Paneth cells that secrete defensins, lysozyme, and TNF).

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6
Q

Digestive tract histology

  • Jejunum
  • Ileum
  • Colon
A

Plicae circulares (also present in distal duodenum) and crypts of Lieberkühn.

Peyer patches, plicae circulares (proximal ileum), and crypts of Lieberkühn. Largest number of goblet cells in the small intestine.

Crypts of Lieberkühn but no villi; abundant goblet cells.

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7
Q

Abdominal aorta and branches

A

Pag. 357

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8
Q

Superior mesenteric artery syndrome

A

Characterized by intermittent intestinal obstruction symptoms (primarily postprandial pain) when SMA and aorta compress transverse (third) portion of duodenum.

Typically occurs in conditions associated with diminished mesenteric fat (eg, low body weight/malnutrition).

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9
Q

Two areas of the colon susceptible in colonic ischemia:

A

ƒƒ Splenic flexure—SMA and IMA

ƒƒ Rectosigmoid junction—the last sigmoid arterial branch from the IMA and superior rectal artery

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10
Q

Celiac trunk

A

Branches of celiac trunk: common hepatic, splenic, and left gastric.

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11
Q

Duodenal ulcers

A

Posterior duodenal ulcers penetrate gastroduodenal artery causing hemorrhage.

Anterior duodenal ulcers perforate into the anterior abdominal cavity, potentially leading to pneumoperitoneum.

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12
Q

Portosystemic anastomoses

- Site of anastomosis + Clinical sign + portal↔ systemic

A
  1. Esophagus. Esophageal varices. Left gastric ↔ azygos
  2. Umbilicus. Caput medusae. Paraumbilical ↔ small
    epigastric veins of the anterior abdominal wall.
  3. Rectum. Anorectal varices. Superior rectal ↔ middle and inferior rectal
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13
Q

transjugular intrahepatic portosystemic shunt (TIPS)

A

between the portal vein and hepatic vein relieves portal hypertension by shunting blood to the systemic circulation, bypassing the liver. Can precipitate hepatic encephalopathy.

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14
Q

Pectinate (dentate) line

  • Above
  • Below
A

internal hemorrhoids, adenocarcinoma. Internal hemorrhoids receive visceral innervation and are therefore not painful.

external hemorrhoids, anal fissures, squamous cell carcinoma. External hemorrhoids receive somatic
innervation (inferior rectal branch of pudendal nerve) and are therefore painful if thrombosed.

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15
Q

Anal fissure

A

Tear in the anal mucosa below the Pectinate line. Pain while Pooping; blood on toilet Paper.

Located Posteriorly because this area is Poorly Perfused.

Associated with low-fiber diets and constipation.

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16
Q

Liver tissue architecture

A

The functional unit of the liver is made up of hexagonally arranged lobules surrounding the central vein with portal triads on the edges (consisting of a portal vein, hepatic artery, bile ducts, as well lymphatics)

17
Q

Liver tissue architecture

  • Zone I—periportal zone:
  • Zone II—intermediate zone:
  • Zone III—pericentral vein (centrilobular) zone:
A

ƒƒ Affected 1st by viral hepatitis
ƒƒ Ingested toxins (eg, cocaine)

ƒƒ Yellow fever

ƒƒ Affected 1st by ischemia
ƒƒHigh concentration of cytochrome P-450
ƒƒMost sensitive to metabolic toxins (eg, ethanol, CCl4, halothane, rifampin)
ƒƒ Site of alcoholic hepatitis

18
Q

Tumors that arise in head of pancreas (ductal adenocarcinoma)

A

can cause obstruction of common bile duct Ž enlarged gallbladder with painless jaundice (Courvoisier sign).

19
Q

Femoral region

Femoral triangle

Femoral sheath

A

you go from lateral to medial to find your “NAVeL”
- Lateral to medial: Nerve-Artery-Vein-Lymphatics

Contains femoral nerve, artery, vein. (inguinal ligament, sartorious and adductor longus)

Fascial tube 3–4 cm below inguinal ligament. Contains femoral vein, artery, and canal (deep inguinal lymph nodes) but not femoral nerve

20
Q

Spermatic cord

A

ICE tie

  • Internal spermatic fascia (transversalis fascia)
  • Cremasteric muscle and fascia (internal oblique)
  • External spermatic fascia (external oblique)
21
Q

Inguinal canal

A

¨Pag. 363

22
Q

Diaphragmatic hernia

A

Abdominal structures enter the thorax. Commonly occurs on left side due to relative protection of right hemidiaphragm by liver. Most commonly a hiatal hernia.

23
Q

Sliding hiatal hernia

A

gastroesophageal junction is displaced upward as gastric cardia slides into hiatus; “hourglass stomach.” Most common type

24
Q

Paraesophageal hiatal hernia

A

gastroesophageal junction is usually normal but gastric fundus protrudes into the thorax.

25
Q

Indirect inguinal hernia

A

Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum.

Caused by failure of processus vaginalis to close (can
form hydrocele). May be noticed in infants or discovered in adulthood.

26
Q

Direct inguinal hernia

A

Protrudes through the inguinal (Hesselbach) triangle.

Bulges directly through parietal peritoneum medial to the inferior epigastric vessels.

Usually occurs in older men due to an acquired weakness in the transversalis fascia.

27
Q

Femoral hernia

A

Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle.

More common in females, but overall inguinal hernias are the most common. *more likely to present with incarceration or strangulation

28
Q

Inguinal (Hesselbach) triangle:

A

ƒƒ Inferior epigastric vessels
ƒƒ Lateral border of rectus abdominis
ƒƒ Inguinal ligament

USMLE 1 (73 decks)

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