gi Flashcards
1
Q
ANATOMY
A
esophagus|EJG|stomach|small bowel - jejunum/ileum|large bowel - asc/trans/desc/sig
2
Q
esophagus extends from ___________ to _______________
A
pharynx to cardiac orifice
3
Q
EJG seen anterior to __________ and post to ________________
A
AO |L liver
4
Q
segment of esophagus between diaphragm and stomach
A
EJG
5
Q
stomach
A
body|fundus|pylorus
6
Q
stomach secretes
A
pepsinogen/bicarbonate/HCl
7
Q
small bowel intra or retroperitoneal?
A
intraperitoneal||EXCEPT 2nd and 4th duodenum
8
Q
fxn of small bowel
A
nutrient absorption
9
Q
c shaped first portion of small bowel divided into 4 sections
A
duodenum||ends at jejunum
10
Q
ampulla of vater located
A
2nd portion duodenum
11
Q
duodenum fxn
A
secrete mucous to protect small bowel from acid
12
Q
second portion of small bowel
A
jejunum
13
Q
stepladder configuration
A
jejunum
14
Q
________________ __________________ intraluminal extensions/folds that increase surface area for absorption ||mostly in jejunum and some in ileum
A
valvulae conniventes
15
Q
jejunum appearance
A
feathery due to valvulae conniventes
16
Q
what bowel terminates at cecum portion of colon in RLQ
A
ileum
17
Q
_______________ valve controls flow from small to large bowel
A
ileocecal valve
18
Q
bacteria in large colon produce
A
vitamin K
19
Q
ascending colon location
A
starts at colon and extends up to hepatic flexure
20
Q
appendiz attached to
A
cecum
21
Q
begins at hepatic flexure and ends at splenic flexure
A
transverse colon
22
Q
from splenic flexure to sigmoid colon
A
descending colon
23
Q
terminal segment of colon
A
sigmoid colon
24
Q
accessory glands of GI tract
A
salivary glands, pancreas, liver
25
ANATOMIC GUT WALL LAYERS
mucosa|submucosa|muscularis|serosa
26
GUT SIGNATURE
1) superficial mucosa - epithelial lining ECHO||2) deep muscosa - loose connective tissue and muscularis mucosa HYPO||3) submucosa - ECHO||4) muscularis propria - HYPO||5) serosa/adventitia - ECHO
27
how many layers seen sonographically?
5 layers
28
normal wall thickness in distended bowel
3 mm
29
normal wall thickeness seen in nondistended bowel
5 mm
30
_________ mm wall thickness abnormal
> 7 mm
31
keyboard sign
haustra of colon ||series of echogenic lobulations
32
HORMONES GI tract
gastrin|CCK|secretin
33
controls release of acid in stomach - food triggers release
gastrin
34
produced by small intestine in response to fat in digestive tract|causes GB contraction
CCK
35
regulates secretions of stomach and pancreas
secretin
36
SYMPTOMS GI TRACT DISEASE
pain / cramping|diarrhea|weight loss|bloating / indigestion|N/V|anemia|leukocytosis
37
labs GI tract
CEA - tumor marker|WBC count - infection/ appendicitis / colitis / diverticulitis|hematocrit - active GI bleed / esophageal varices
38
GI tract probe
3 - 5 MHZ linear
39
arteries that supply the GI tract, liver, spleen, pancreas
splanchnic arteries
40
splanchnic arteries include
CA|SMA|IMA|SA
41
CA|____________ branch of AO|________ cm below diaphragm|________ cm long|___________ to body of pancreas|divides into __________ ___________ __________|______________ sign
ant|2|1|superior|CHA , LGA, SA|seagull
42
CHA|___________ branch of CA|supplies ___________ ____________and__________|travels along ________________|______________ to PV|_____________ branches from CHA|branches of CHA|GDA supplies __________________
right|liver, GB, stomach|superior border of pancreatic head|anterior to PV|RGA|PHA / GDA|stomach , duodenum , pancreas
43
SA|tortuous course _____________ and __________ to panc body and tail|supplies _______ ____________ and ___________
largest branch of CA|posterior and superior|spleen , pancreas, stomach fundus
44
LGA|travels _____________ and _____________|supplies ___________ and ____________
smallest branch of CA|anterior and cephalad|stomach and pylorus
45
GI tract probe
2.5 - 6.5 MHZ adult|4 - 8 MHZ pediatric||NPO 8-12
46
splanchnic artery resistance
low - feeding organs needing constant flow
47
occlusive disease may cause
increased velocity and resistance ||> 70% stenosis PSV > 2.0 m/s
48
intermittent compressiion of CA
median arcuate ligament syndrome
49
caused by diaphragm moving superiorly and median arcuate ligament pinching the CA
median arcuate ligament syndrome
50
MALS - w/ expiration
pain|increased velocities in CA
51
SMA |_____________ branch AO __________ cm below CA|runs __________ to AO |__________________ to pancreas neck|___________ of SMV|supplies _________ and ___________
anterior / 1-2 cm |parallel|posterior|left of SMV|small intestine and prox colon
52
indications to scan SMA
post pradial pain|weight loss|fear of food|diarrhea|N/V
53
if 2 mesenteric vessels demonstrate stenosis
mesenteric ischemia||stenosis occurs in first 2-3 cm of vessel
54
normal post prandial flow SMA
low resistance |increased velocity
55
IMA|courses __________ in abdomen to supply _________|___________ to IMV|stenosis/occlusion can cause|LOCATED __________to RVs
inferiorly ---> distal colon|medial to IMV|mesenteric ischemia|inferior
56
stenosis / occlusion of at least 2 of 3 major splanchnic arteries (CA/IMA/SMA)
mesenteric ischemia
57
acute mesenteric ischemia caused by ____________--|chronic mesenteric ischemia caused by ___________
embolus|atherosclerosis
58
what is dilated w/ chronic mesenteric ischemia
IMA
59
DOPPLER INTERPRETATION mesenteric ischemia
mesenteric PSV / AO PSV ratio = > 3.0 |significant stenosis||SMA - abnormal PSV > 2.75 m/s = >70% stenosis|- increased diastolic flow||CA - abnormal PSV > 2.0 m/s = > 70% stenosis|- no change in flow with digestion||IMA - abnormal PSV > 2.0 m/s indicates stenosis
60
SMA and IMA low res w/ increased diastolic flow even in fasting patient -
cap beds vasodilated due to ischemia
61
retro flow in CHA and SA suggestive of
celiac occlusion
62
post prandial - HA will demonstrate
increased RI due to increased PV inflow to liver w/ digestion||increased RI = increased PSV and decreased EDV
63
hypertrophy of pyloric muscle controlling digestive flow out of stomach
pyloric stenosis
64
present w/ small palpable mass just inf to xiphoid process - olive sign
pyloric stenosis
65
4:1 male to female ratio||2-10 wks af age
pyloric stenosis
66
neonate presents w/ projectile vomiting and palpable olive mass
pyloric stenosis
67
enlarged pylors palpable in infant abdomen
olive sign
68
cross sectional appearance of pylorus on US
donut sign
69
used to describe the long section appearance of pylorus on US
cervix sign
70
measure what 3 things w / pyloric stenosis
muscle thickeness|channel length|cross sectional diameter
71
muscle thickeness|channel length|cross section
muscle thickness > 4mm|channel length > 1.2 mm|cross section > 1.5 mm
72
SA pyloric stenosis
excessive muscle wall thickness
73
small pouch in wall of intestine
meckels diverticulum
74
develops due failure of vitelline duct to obliterate in fetal development
meckels diverticulum
75
most common congential anaomaly of GI tract
meckels diverticulum
76
symptoms meckels diverticulum
most asymptomatic|GI hemorrhage mc symptom
77
SA |meckels diverticulum
blind ended fluid filled bowel loop connected to normal perstalsing bowel segment in RLQ
78
chronic inflammatory disorder of GI tract of unknown etiology
crohn disease
79
crohn disease mc affects
terminal ileum||- gut wall thickens creating rigid secondary lumen
80
chrone disease complications
inflammatory masses - phlegmon/abcess
81
SA crohn disease
concentric wall thickening > 3 mm|mesenteric fatty proliferation (creeping fat)|hyperemia|strictures|abcess|mesenteric lymphadenopathy|pseudokidney|wall echo varies w/ infection
82
LLQ pain / fever / increased WBC
diverticulitis
83
acute RLQ pain ass ___________|acute LLQ pain ass _________
appendicitis |diverticulitis
84
inflammation of diverticulum causing segmental concentric thickening of wall|commonly in sigmoid colon
diverticulitis
85
SA diverticulits
inflamed diverticula (out pouching wall > 4mm)|echogenic round structures||echogenic areas in wall|pseudokidney sign - abnormal thickening
86
inflammation of colon
colitis||-diffuse or focal
87
low fever / diarrhea / pain
colitis
88
ulcerations form w/in wall|usually affects sigmoid colon and rectum|bacteria invades bld and enters PV sysem|gas released in PV system|- dirty shadowing and ring down
ulcerative colitis
89
ass w/ primary sclerosing cholangitis
ulcerative colitis
90
SA ulcerative colitis
thickened walls > 5 mm|reduced peristalsis|loss haustra- more tubular|fluid collection|wall vascularity
91
vermiform appendix usually protrudes from ___________|seen _____________ to termimal ileum and ____________ to iliac vessels
posteromedial cecum|posterior|anterior
92
acute appendicitis occurs in patients ages __________
30-Oct
93
most common cause of acute abdominal pain
acute apendicitis
94
acute appendicitis symptoms
acute rLQ pain|increased WBC|rebound tenderness
95
pain and tenderness at Mcburneys point associated w/ appendicitis
Mcburneys sign
96
occurs when appendix becomes inflamed and filled with pus
appendicitis
97
caused by obstruction of appendiceal lumen by fecalith or hyperplasia of submucosa|-mucosal secretions increase intraluminal pressure and compromise venous and lymphatic drainage|- bacterial infection leads to gangrene and perforation = peritonitis
acute appendicitis
98
hard stony mass of feces in intestinal tract that can obstruct the appendix leading to appendicitis
fecalith (coprolith/sterocolith)
99
SA acute appendicitis
blind ended structure does not compress|aperistaltic tube w/ gut signature|diameter > 6 mm|wall > 2 mm|target sign|fluid collection|inflamed perienteric fat|increased wall vascularity||loss normal echogenic submucosal layer + no color = gangrenous appendix||echogenic shadowing fecalith
100
loculated pericecal fluid|phelgmon|abscess|prominetn pericecal fat
perforated appendix
101
appendix obstructed by scarring or fecaliths|isolated segment continues to produce mucous causing formation of retrocecal mass||asymptomatic|50% have palpable RLQ mass|benign
mucocele of appendix
102
SA mucocele of appendix
elongated appendix w/ mucous|wall thick or normal|onion sign|varying echogenicity and calcifications
103
thick fatty strands that attach to serosal surface of colon
epiploic appendagitis
104
torsion or thrombosis can cause ischemia or infarction|-- localized pain and inflammation
epiploic appendagitis
105
SA |epiploic appendagitis
echogenic finger like projection from colon wall|pericolic fat thick and echogenic||(can look like appendicitis - look for wall layers seen w/ appendix but not epi appen)
106
bowel obstruction|fxnal:|mechanical:
fxnal : paralysis of muscle in bowel wall - lack peristalsis|most |mechanical : physical impediment to lumen
107
mechanical bowel obstruction causes
material in lumen|intrinsic/extrinsic masses|circulatory compromise
108
most common cause of bowel obstruction
adhesions
109
intraluminal masses of undigested material
bezoar
110
___________ inorganic substance / meds / bubble gum|___________ hair ball|____________ indigestible plant or vegetable materials |_________ milk materials seen in infants
concretions|trichobezoar|phytobezoar|lactobezoar
111
SA eval of bowel obstruction
describe location gut loops|caliber of segment and size of obstruction|contents of segment|peristalsis?
112
SA bowel obstruction
dilatation GI tract prox to obstruction|assess caliber|content (fluid v gas)|peristalsis|site luminal obs|location of gut loops
113
most commonly occurs at ileocecal junction in RLQ
intussusception ref
114
small intestine (ileum) involutes into large bowel (cecum)||- lymph nodes, mesentery, and bld vessels can be pulled into large intestine too
intussuscpetion
115
most common cause small bowel obstruction in children 6 mo to 4 yrs
intussusception
116
severe pain w/ peristalsis / vomiting / blood in rectum||anemia|dehydration|leukocytosis
intussusception
117
classic signs of intussesception
vomiting|abdominal pain|rectal bleeding
118
SA intussusception
oval pseudokidney appearing mass|non comp|target|thickened walls folded over each other
119
refers to any variation in normal rotation and fixation of GI tract during deveoplment
midgut malrotation
120
most common portsystemic collateral seen w/ midgut malroation?
Left gastric vein
121
midgut malrotation is ass w/ malposition of
SMA and SMV
122
SA midgut malrotation
reversed position SMA and SMV|flow reversal in left gastric vein
123
third leading of death from cancer
colon cancer - adenocarcinoma
124
most common location of colon cancer
rectal carcinoma
125
most common malignant tumor of GI tract
adenocarcinoma||-increased levels CEA
126
gastric tumors arise in
pre-pyloric|antrum|lesser curve
127
SA adenocarcinoma
solid intraluminal mass carying echo
128
endoscopic sonography
7.5 MHZ|LLD|used to localize / characterize benign masses|staging esophageal cancer|differentiating astric lymphoma from carcinoma
129
transrectal US
LLD/ LITHOMY|enema|staging rectal cancer
130
primary or widespread|nodular . ulcerative/ infiltrating|common in AIDS patients
lymphoma
131
SA lymphoma
large hypoechoic ulcerated masses|in stomach or small bowel|gas artifact
132
mets
breat lung and melanoma
133
SA mets
multiple small ulcerated nodules|hard to differ from primary
