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Digestion And Metabolism > Gastrointestinal System II > Flashcards

Gastrointestinal System II Flashcards

1
Q

What is the esophagus?

A

Esophagus
•Part of foregut
•25cm long
•Location-neck, thorax & abdomen

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2
Q

Describe the musculature of esophagus

A

The musculature of esophagus :

Skeletal - upper 1/3 mixed - middle 1/3 Smooth - lower 1/3

  • Pierces the diaphragm at the level of T10.
  • Below the diaphragm, is covered by peritoneum.
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3
Q

What do the right and peft gastric artery supply?

A

Left gastric : Branch of the celiac trunk .Supplies the lower part of the
esophagus and upper left part of the stomach.

Right gastric :Arises from the hepatic artery and run along the lesser
curvature of the stomach

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4
Q

What does the short gastric supply?

A

Short gastric :Arises from the splenic artery. Supplies the fundus.

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5
Q

What does the left and rightbgastroepiploic artery?

A

Left gastroepiploic :Arises from the splenic artery then passes forward to supply the upper part of the greater curvature of the stomach

Right gastroepiploic : Arises from the gastroduodenal branch of the hepatic artery. supplies right lower part of stomach along the greater curvature.

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6
Q

What are the venous supply of the stomach?

A

Veins all drain into the portal system
Left and right gastric drain into the portal vein directly

The short gastrics and left gastroepiploic veins drain into the splenic vein
Lymphatic channels from the stomach will first drain to the celiac group of lymph nodes located around the celiac trunk.

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7
Q

What is perforated peptic ulcer?

A

•Sudden and severe pain in the abdomen •Board like rigidity of the abdomen =peritoneal irritation

•Abnormal finding of “free air” under the
diaphragm

•If ulcer has perforated into a surrounding vessel
then excessive bleeding may cause hemodynamic compromise

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8
Q

What are peptice ulcers?

A
  • Ulcers occur most commonly in the first part of the duodenum, called the duodenal bulb.
  • Flow of acid through the pyloric valve is directed toward the posterior wall of the bulb.
  • Deep ulceration can invade the gastroduodenal artery or its branches (posterior superior pancreaticoduodenal artery)
  • The secondary site of occurrence is along the lesser curvature of the stomach.
  • Anterior Duodenal ulcers = peritoneal cavity = peritonitis
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9
Q

What is the importance of the lesser sac?

A

Importance of lesser sac:

Perforation to posterior wall of stomach (eg. gastric ulcer) can lead to spilling of gastric contents, inducing > peritonitis > pancreatitis

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10
Q

What are the arteries of the celiac trunk?

A 
Identify:
1. Proper hepatic 
2. Common hepatic 
3. Gastroduodenal 
4. Splenic
Other arteries seen but not branches of the celiac trunk:
5.Renal arteries
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11
Q

What are small intestine?

A
  • Extends from the pyloric orifice of the stomach to the ileocecal junction
  • Main site of absorption

Consists
• Duodenum •
jejunum
• Ileum

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12
Q

What is the duodenum?

A

forms a “C” shaped loop around the head of the pancreas

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13
Q

What are the parts of the duodenum?

A

1st - superior: located at L1 vertebra, proximal
part called the duodenal bulb, is suspended by a Mesentary

2nd – descending : located along the right side of L1-L3 vertebrae. Contains the hepatopancreatic duct, major and minor duodenal papilla and the accessory pancreatic duct.

3rd - horizontal –crosses to the left ,anterior to the IVC, aorta, vertebral level L3,along the inferior border of the pancreas

4th - ascending – ascends along the left side of the aorta to the level of L2 at the inferior border of the pancreas . Joins the jejunum at the duodenojejunal flexure suspended from the posterior wall by the ligament of Treitz

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14
Q

Describe the 1 st portion of the duodenum

A

Duodenal cap

No plicae found here

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15
Q

Describe the 2nd portion of the duodenum

A

plicae (semilunar folds)

Openings of hepato-pancreatic duct

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16
Q

Describe the 3rd portion of the duodenum

A

against aorta & vena cava Superior mesenteric vessels run anterior to it

17
Q

Describr the 4th portion of the duodenum

A

anchored to diaphragm by means of ligament of Treitz

18
Q

Describe the jejunum

A 
Jejunum
▪ Proximal 2/5 of the small intestine
▪ Suspended by mesentery
▪ Thicker walls and larger in diameter than
ileum
▪ Tall closely packed circular folds
▪ “Feathery” appearance on radiography
▪ Widely spaced arterial arcades within the
mesentery
▪ Long vasa recta -
19
Q

Describe the ileum

A

▪ Distal 3/5 of the small intestine

▪ Ends at the ileocecal junction

▪ Lymphoid nodules –Peyer’s patches ▪ Smooth appearance on radiography ▪ Denser arterial arcades

▪ Shorter vasa recta

20
Q

Describe the main arteries of the small intestines

A

Main Artery:
• Superior mesenteric
• Veins correspond to the arteries and these veins drain into the superior mesenteric vein

• Lymphatic channels from small intestine will drain ultimately into superior mesenteric nodes

21
Q

What is the significance of the appendix?

A
  • Embryologically, the appendix is innervated by T10, as is the periumbilical region; thus, there is often referral of pain to this area initially in appendicitis. Visceral Afferent fibers will carry pain from the appendix to DRG
  • With contact of the inflamed appendix with the body wall, pain is usually felt in the right lower quadrant. This pain will be Somatic Afferent fibers that will carry pain from the parietal peritoneum (body wall) to DRG
22
Q

What is rebound tenderness?

A

• To confirm the diagnosis of appendicitis the examiner can compress, and then rapidly release the pressure applied to the right lower quadrant. Because of the peritoneal irritation, the patient may experience sudden, sharp pain on the right side, in the region of the infected appendix

23
Q

Where does the appendix lie?

A
  • The appendix lies in the right iliac fossa and in relation to the anterior abdominal wall its base is situated one third the way up a line joining the right anterior iliac spine to the umbilicus (Mc Burnie’s point).
  • Its base is attached to the posteromedial surface of the cecum below the ileocecal junction.
  • Completely surrounded by peritoneum –mesoappendix
  • Blood supply is derived from the appendicular artery via the ileocolic arter
24
Q

What is the psoas test?

A

Psoas test is elicited by passively extending the thigh of a patient lying on their side with knees extended, or asking the patient to actively flex their thigh at the hip. If abdominal pain occurs this is positive psoas sign or test. The pain results because the psoas muscles is stretching (by hyperextension at the hip) or contracting (by flexion of the hip) causing friction against nearby inflamed tissues. Psoas test is used to test for appendicitis

25
Q

What are the signs of a small obstruction?

A

•Small bowel obstruction
tends to be located centrally.

  • Increased intra luminal gas
  • “Stacks of coins appearance”-plica semilunaris Lines are continuous from luminal wall to luminal wall.

To understand bowel obstruction think of the GI tract as a tube. Obstruction at any point along the tube cause that part of the tube proximal to the point of the obstruction to be dilated and the part located distally to be flattened

26
Q

What is the clinical significance of a small bowel obstruction?

A
  • Nausea and vomiting
  • Abdominal distention.
  • On physical examination increase bowel sounds
  • No passage of gas per rectum
27
Q

Where is the hepatogastruc ligament?

A
28
Q

Describe the arterial supply of the GI

A
29
Q

Describe the perforated peptic ulcer

A
30
Q

What are the locations f ulcer perforations?

A
31
Q

What’s the importance of the lesser sac?

A
32
Q

What are the arteries of the celiac trunk ?

A
33
Q

What does the stomach and liver look like on an CT?

A
34
Q

Where does the a

A

Digestion And Metabolism (57 decks)

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