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Gastrointestinal - The Basics Flashcards

1
Q

foregut

A

pharynx to duodenum

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2
Q

midgut

A

duodenum to transverse colon

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3
Q

hindgut

A

distal transverse colon to rectum

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4
Q

developmental defects of anterior abdominal wall due to failure of:

A
  • rostral fold closure: sternal defects
  • lateral fold closure: omphalocele, gastroschisis
  • caudal fold closure: bladder exstrophy
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5
Q

duodenal atresia

A

failure to recanalize (trisomy 21)

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6
Q

jejunal, ileal, colonic atresia

A

due to vascular accident (apple peel atresia)

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7
Q

midgut development

A

6th week - midgut herniates through umbilical ring

10th week - returns to abdominal cavity + rotates around SMA

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8
Q

gastroschisis

A

extrusion of abdominal contents through abdominal folds; not covered by peritoneum

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9
Q

omphalocele

A

persistence of herniation of abdominal contents into umbilical cord, covered by peritoneum

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10
Q

most common transesophageal anomaly

A

esophageal atresia with distral transesophageal fistula

EA + TEF

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11
Q

congenital pyloric stenosis

A

hypertrophy of pylorus causes obstruction
“olive” mass in epigastric region, nonbilious projectile vomiting ~ 2 wks.
firstborn males

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12
Q

annular pancreas

A

ventral pancreatic bud abnormally encircled 2nd part of duodenum; forms a ring of pancreatic tissue that may cause duodenal narrowing

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13
Q

pancreas divisum

A

ventral and dorsal parts fail to fuse at 8 weeks

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14
Q

retroperitoneal structures

A 
SAD PUCKER
Suprarenal/adrenal gland
Aorta and IVC
Duodenum (2nd, 3rd parts)
Pancreas (except tail)
Ureters
Colon (descending and ascending)
Kidneys
Esophagus (lower 2/3)
Rectum (lower 2/3)
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15
Q

falciform ligament connects

A

liver to anterior abdominal wall

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16
Q

falciform ligament contains

A

ligamentum teres hepatis (derivative of fetal umbilical vein)

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17
Q

falciform ligament fun fact

A

derivative of ventral mesentery

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18
Q

hepatoduodenal ligament connects

A

liver to duodenum

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19
Q

hepatoduodenal ligament contains

A

portal triad
hepatic artery
portal vein
common bile duct

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20
Q

hepatoduodenal ligament fun facts

A

Pringle maneuver - control bleeding

connects greater and lesser sacs

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21
Q

gastrohepatic ligament connects

A

liver to lesser curvature of stomach

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22
Q

gastrohepatic ligament contains

A

gastric arteries

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23
Q

gastrohepatic ligament fun facts

A

separates greater and lesser sacs on the right

may be cut during surgery to access lesser sac

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24
Q

gastrocolic ligament connects

A

greater curvature and transverse colon

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25
Q

gastrocolic ligament contains

A

gastroepiploic arteries

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26
Q

gastrocolic ligament fun fact

A

part of greater omentum

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27
Q

gastrosplenic ligament connects

A

greater curvature and spleen

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28
Q

gastrosplenic ligament contains

A

short gastrics, left gastroepiploic vessels

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29
Q

gastrosplenic ligament fun fact

A

separates greater and lesser sacs on the left

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30
Q

splenorenal ligament connects

A

spleen to posterior abdominal wall

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31
Q

splenorenal ligament contains

A

splenic artery and vein, tail of pancreas

32
Q

Gut wall layers - inside to outside

A

MSMS
Mucosa - epithelium, lamina propria, muscularis mucosa
Submucosa - submucosal nerve plexus/Meissner’s
Muscularis externa - myenteric/Auerbach’s
Serosa (intraperitoneal)/Adventitia (retroperitoneal)

33
Q

Slow wave frequency
Stomach
Duodenum
Ileum

A

Stomach - 3 waves/min
Duodenum - 12 waves/min
Ileum - 8-9 waves/min

34
Q

esophagus histology

A

nonkeritanized stratified squamous epithelium

35
Q

stomach histology

A

gastric glands

36
Q

duodenum histology

A

villi, microvilli increase absorptive surface
Brunner’s glands (submucosa)
crypts of Lieberkuhn

37
Q

jejunum histology

A

plicae circulares, crypts of Lieberkuhn

38
Q

ileum histology

A

Peyer’s patches (lamina propria, submucosa)
plicase circulares (proximal ileum)
crypts of Lieberkuhn
largest number of goblet cells

39
Q

colon histology

A

crypts
no villi
numerous goblet cells

40
Q

Superior mesenteric artery syndrome

A

transverse portion (3rd segment) of duodenum is entrapped between SMA and aorta, causing intestinal obstruction

41
Q

celiac trunk level

42
Q

SMA level

43
Q

left renal artery level

44
Q

inferior mesenteric artery level

45
Q

bifurcation of abdominal aorta level

46
Q

foregut blood supply

A

celiac artery

47
Q

foregut parasym innervation

48
Q

foregut structures supplied

A 
stomach to proximal duodenum
liver
gallbladder
pancreas
spleen (mesoderm)
49
Q

midgut blood supply

50
Q

midgut parasym innervation

51
Q

midgut structures supplied

A

distal duodenum to proximal 2/3 transverse colon

52
Q

hindgut blood supply

53
Q

hindgut parasym innervation

54
Q

hindgut structures supplied

A

distal 1/3 transverse colon to upper portion of rectum; splenic flexure is a watershed region

55
Q

celiac trunk branches - think main blood supply of stomach

A

common hepatic
splenic
left gastric

56
Q

strong anastomoses of celiac trunk

A

left and right gastroepiploics

left and right gastrics

57
Q

blocked abdominal aorta branches - anastomotic compensation for arteries

A

superior epigastric + inferior epigastric
superior pancreaticoduodenal + inferior pancreaticoduodenal
middle colic + left colic
superior rectal + middle and inferior rectal

58
Q

portosystemic anastomoses - think portal HTN

A

esophagus - esophageal varices
umbilicus - caput medusa
rectum - internal hemorrhoids

59
Q

esophageal varices anastomosis

A

left gastric (portal) + esophageal (systemic)

60
Q

caput medusa anastomoses

A

paraumbilical (portal) + superficial & inferior epigastric below umbilicus, superior epigastric & lateral thoracic above umbilicus (systemic)

61
Q

internal hemorrhoids anastomoses

A

superior rectal (portal) + middle & inferior rectal (systemic)

62
Q

portal HTN Tx

A

TIPS - transjugular intrahepatic portosystemic shunt

btwn portal & hepatic vv., shunt to systemic

63
Q

internal hemorrhoids

A

painless, above pectinate line

venous drainage: superior rectral vein to inferior mesenteric vein to portal system

64
Q

external hemorrhoids

A

painful, below pectinate line

venous drainage: inferior rectal vein to internal pudendal vein to internal iliac vein to IVC

65
Q

The Liver

Zone I: periportal zone

A

affected 1st by vital hepatitis

66
Q

The Liver

Zone II: intermediate zone

A

just a thing

67
Q

The Liver

Zone III: pericentral vein/ centrilobular zone

A

affected 1st by ischemia
contains P450 system
most sensitive to toxic injury
site of EtOH hepatitis

68
Q

The Liver

Blood flow

A

Zone I to III

69
Q

The Liver

Bile flow

A

Zone III to I

70
Q

femoral region contents lateral to medial

A

NAVEL
Nerve, Artery, Vein, Empty space, Lymphatics
femoral sheath contains all but nerve

71
Q

diaphragmatic hernia

A

abdominal structures enter the thorax

hiatal hernia most common - stomach herniates upward through esophageal hiatus of diaphragm

72
Q

indirect inguinal hernia

A

through the internal (deep) inguinal ring, external (superficial) inguinal ring, into scrotum
male infants - descent of testes
lateral to inferior epigastric artery

73
Q

direct inguinal hernia

A

protrudes through inguinal (Hesselbach’s) triangle
medial to inferior epigastric artery
through external (superficial) inguinal ring only
older men

74
Q

femoral hernia

A

protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle
more common in women

75
Q

Hesselbach’s triangle borders

A

inferior epigastric vessels
laterial border rectus abdominis
inguinal ligament

First Aid (6 decks)

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