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test > gi > Flashcards

gi Flashcards

1
Q

ANATOMY

A

esophagus|EJG|stomach|small bowel - jejunum/ileum|large bowel - asc/trans/desc/sig

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2
Q

esophagus extends from ___________ to _______________

A

pharynx to cardiac orifice

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3
Q

EJG seen anterior to __________ and post to ________________

A

AO |L liver

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4
Q

segment of esophagus between diaphragm and stomach

A

EJG

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5
Q

stomach

A

body|fundus|pylorus

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6
Q

stomach secretes

A

pepsinogen/bicarbonate/HCl

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7
Q

small bowel intra or retroperitoneal?

A

intraperitoneal||EXCEPT 2nd and 4th duodenum

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8
Q

fxn of small bowel

A

nutrient absorption

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9
Q

c shaped first portion of small bowel divided into 4 sections

A

duodenum||ends at jejunum

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10
Q

ampulla of vater located

A

2nd portion duodenum

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11
Q

duodenum fxn

A

secrete mucous to protect small bowel from acid

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12
Q

second portion of small bowel

A

jejunum

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13
Q

stepladder configuration

A

jejunum

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14
Q

________________ __________________ intraluminal extensions/folds that increase surface area for absorption ||mostly in jejunum and some in ileum

A

valvulae conniventes

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15
Q

jejunum appearance

A

feathery due to valvulae conniventes

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16
Q

what bowel terminates at cecum portion of colon in RLQ

A

ileum

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17
Q

_______________ valve controls flow from small to large bowel

A

ileocecal valve

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18
Q

bacteria in large colon produce

A

vitamin K

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19
Q

ascending colon location

A

starts at colon and extends up to hepatic flexure

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20
Q

appendiz attached to

A

cecum

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21
Q

begins at hepatic flexure and ends at splenic flexure

A

transverse colon

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22
Q

from splenic flexure to sigmoid colon

A

descending colon

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23
Q

terminal segment of colon

A

sigmoid colon

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24
Q

accessory glands of GI tract

A

salivary glands, pancreas, liver

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25
Q

ANATOMIC GUT WALL LAYERS

A

mucosa|submucosa|muscularis|serosa

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26
Q

GUT SIGNATURE

A

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

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27
Q

how many layers seen sonographically?

A

5 layers

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28
Q

normal wall thickness in distended bowel

A

3 mm

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29
Q

normal wall thickeness seen in nondistended bowel

A

5 mm

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30
Q

_________ mm wall thickness abnormal

A

> 7 mm

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31
Q

keyboard sign

A

haustra of colon ||series of echogenic lobulations

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32
Q

HORMONES GI tract

A

gastrin|CCK|secretin

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33
Q

controls release of acid in stomach - food triggers release

A

gastrin

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34
Q

produced by small intestine in response to fat in digestive tract|causes GB contraction

A

CCK

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35
Q

regulates secretions of stomach and pancreas

A

secretin

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36
Q

SYMPTOMS GI TRACT DISEASE

A

pain / cramping|diarrhea|weight loss|bloating / indigestion|N/V|anemia|leukocytosis

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37
Q

labs GI tract

A

CEA - tumor marker|WBC count - infection/ appendicitis / colitis / diverticulitis|hematocrit - active GI bleed / esophageal varices

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38
Q

GI tract probe

A

3 - 5 MHZ linear

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39
Q

arteries that supply the GI tract, liver, spleen, pancreas

A

splanchnic arteries

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40
Q

splanchnic arteries include

A

CA|SMA|IMA|SA

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41
Q

CA|____________ branch of AO|________ cm below diaphragm|________ cm long|___________ to body of pancreas|divides into __________ ___________ __________|______________ sign

A

ant|2|1|superior|CHA , LGA, SA|seagull

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42
Q

CHA|___________ branch of CA|supplies ___________ ____________and__________|travels along ________________|______________ to PV|_____________ branches from CHA|branches of CHA|GDA supplies __________________

A

right|liver, GB, stomach|superior border of pancreatic head|anterior to PV|RGA|PHA / GDA|stomach , duodenum , pancreas

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43
Q

SA|tortuous course _____________ and __________ to panc body and tail|supplies _______ ____________ and ___________

A

largest branch of CA|posterior and superior|spleen , pancreas, stomach fundus

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44
Q

LGA|travels _____________ and _____________|supplies ___________ and ____________

A

smallest branch of CA|anterior and cephalad|stomach and pylorus

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45
Q

GI tract probe

A

2.5 - 6.5 MHZ adult|4 - 8 MHZ pediatric||NPO 8-12

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46
Q

splanchnic artery resistance

A

low - feeding organs needing constant flow

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47
Q

occlusive disease may cause

A

increased velocity and resistance ||> 70% stenosis PSV > 2.0 m/s

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48
Q

intermittent compressiion of CA

A

median arcuate ligament syndrome

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49
Q

caused by diaphragm moving superiorly and median arcuate ligament pinching the CA

A

median arcuate ligament syndrome

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50
Q

MALS - w/ expiration

A

pain|increased velocities in CA

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51
Q

SMA |_____________ branch AO __________ cm below CA|runs __________ to AO |__________________ to pancreas neck|___________ of SMV|supplies _________ and ___________

A

anterior / 1-2 cm |parallel|posterior|left of SMV|small intestine and prox colon

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52
Q

indications to scan SMA

A

post pradial pain|weight loss|fear of food|diarrhea|N/V

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53
Q

if 2 mesenteric vessels demonstrate stenosis

A

mesenteric ischemia||stenosis occurs in first 2-3 cm of vessel

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54
Q

normal post prandial flow SMA

A

low resistance |increased velocity

55
Q

IMA|courses __________ in abdomen to supply _________|___________ to IMV|stenosis/occlusion can cause|LOCATED __________to RVs

A

inferiorly —> distal colon|medial to IMV|mesenteric ischemia|inferior

56
Q

stenosis / occlusion of at least 2 of 3 major splanchnic arteries (CA/IMA/SMA)

A

mesenteric ischemia

57
Q

acute mesenteric ischemia caused by ____________–|chronic mesenteric ischemia caused by ___________

A

embolus|atherosclerosis

58
Q

what is dilated w/ chronic mesenteric ischemia

A

IMA

59
Q

DOPPLER INTERPRETATION mesenteric ischemia

A

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
Q

SMA and IMA low res w/ increased diastolic flow even in fasting patient -

A

cap beds vasodilated due to ischemia

61
Q

retro flow in CHA and SA suggestive of

A

celiac occlusion

62
Q

post prandial - HA will demonstrate

A

increased RI due to increased PV inflow to liver w/ digestion||increased RI = increased PSV and decreased EDV

63
Q

hypertrophy of pyloric muscle controlling digestive flow out of stomach

A

pyloric stenosis

64
Q

present w/ small palpable mass just inf to xiphoid process - olive sign

A

pyloric stenosis

65
Q

4:1 male to female ratio||2-10 wks af age

A

pyloric stenosis

66
Q

neonate presents w/ projectile vomiting and palpable olive mass

A

pyloric stenosis

67
Q

enlarged pylors palpable in infant abdomen

A

olive sign

68
Q

cross sectional appearance of pylorus on US

A

donut sign

69
Q

used to describe the long section appearance of pylorus on US

A

cervix sign

70
Q

measure what 3 things w / pyloric stenosis

A

muscle thickeness|channel length|cross sectional diameter

71
Q

muscle thickeness|channel length|cross section

A

muscle thickness > 4mm|channel length > 1.2 mm|cross section > 1.5 mm

72
Q

SA pyloric stenosis

A

excessive muscle wall thickness

73
Q

small pouch in wall of intestine

A

meckels diverticulum

74
Q

develops due failure of vitelline duct to obliterate in fetal development

A

meckels diverticulum

75
Q

most common congential anaomaly of GI tract

A

meckels diverticulum

76
Q

symptoms meckels diverticulum

A

most asymptomatic|GI hemorrhage mc symptom

77
Q

SA |meckels diverticulum

A

blind ended fluid filled bowel loop connected to normal perstalsing bowel segment in RLQ

78
Q

chronic inflammatory disorder of GI tract of unknown etiology

A

crohn disease

79
Q

crohn disease mc affects

A

terminal ileum||- gut wall thickens creating rigid secondary lumen

80
Q

chrone disease complications

A

inflammatory masses - phlegmon/abcess

81
Q

SA crohn disease

A

concentric wall thickening > 3 mm|mesenteric fatty proliferation (creeping fat)|hyperemia|strictures|abcess|mesenteric lymphadenopathy|pseudokidney|wall echo varies w/ infection

82
Q

LLQ pain / fever / increased WBC

A

diverticulitis

83
Q

acute RLQ pain ass ___________|acute LLQ pain ass _________

A

appendicitis |diverticulitis

84
Q

inflammation of diverticulum causing segmental concentric thickening of wall|commonly in sigmoid colon

A

diverticulitis

85
Q

SA diverticulits

A

inflamed diverticula (out pouching wall > 4mm)|echogenic round structures||echogenic areas in wall|pseudokidney sign - abnormal thickening

86
Q

inflammation of colon

A

colitis||-diffuse or focal

87
Q

low fever / diarrhea / pain

A

colitis

88
Q

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

A

ulcerative colitis

89
Q

ass w/ primary sclerosing cholangitis

A

ulcerative colitis

90
Q

SA ulcerative colitis

A

thickened walls > 5 mm|reduced peristalsis|loss haustra- more tubular|fluid collection|wall vascularity

91
Q

vermiform appendix usually protrudes from ___________|seen _____________ to termimal ileum and ____________ to iliac vessels

A

posteromedial cecum|posterior|anterior

92
Q

acute appendicitis occurs in patients ages __________

A

30-Oct

93
Q

most common cause of acute abdominal pain

A

acute apendicitis

94
Q

acute appendicitis symptoms

A

acute rLQ pain|increased WBC|rebound tenderness

95
Q

pain and tenderness at Mcburneys point associated w/ appendicitis

A

Mcburneys sign

96
Q

occurs when appendix becomes inflamed and filled with pus

A

appendicitis

97
Q

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

A

acute appendicitis

98
Q

hard stony mass of feces in intestinal tract that can obstruct the appendix leading to appendicitis

A

fecalith (coprolith/sterocolith)

99
Q

SA acute appendicitis

A

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
Q

loculated pericecal fluid|phelgmon|abscess|prominetn pericecal fat

A

perforated appendix

101
Q

appendix obstructed by scarring or fecaliths|isolated segment continues to produce mucous causing formation of retrocecal mass||asymptomatic|50% have palpable RLQ mass|benign

A

mucocele of appendix

102
Q

SA mucocele of appendix

A

elongated appendix w/ mucous|wall thick or normal|onion sign|varying echogenicity and calcifications

103
Q

thick fatty strands that attach to serosal surface of colon

A

epiploic appendagitis

104
Q

torsion or thrombosis can cause ischemia or infarction|– localized pain and inflammation

A

epiploic appendagitis

105
Q

SA |epiploic appendagitis

A

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
Q

bowel obstruction|fxnal:|mechanical:

A

fxnal : paralysis of muscle in bowel wall - lack peristalsis|most |mechanical : physical impediment to lumen

107
Q

mechanical bowel obstruction causes

A

material in lumen|intrinsic/extrinsic masses|circulatory compromise

108
Q

most common cause of bowel obstruction

A

adhesions

109
Q

intraluminal masses of undigested material

A

bezoar

110
Q

___________ inorganic substance / meds / bubble gum|___________ hair ball|____________ indigestible plant or vegetable materials |_________ milk materials seen in infants

A

concretions|trichobezoar|phytobezoar|lactobezoar

111
Q

SA eval of bowel obstruction

A

describe location gut loops|caliber of segment and size of obstruction|contents of segment|peristalsis?

112
Q

SA bowel obstruction

A

dilatation GI tract prox to obstruction|assess caliber|content (fluid v gas)|peristalsis|site luminal obs|location of gut loops

113
Q

most commonly occurs at ileocecal junction in RLQ

A

intussusception ref

114
Q

small intestine (ileum) involutes into large bowel (cecum)||- lymph nodes, mesentery, and bld vessels can be pulled into large intestine too

A

intussuscpetion

115
Q

most common cause small bowel obstruction in children 6 mo to 4 yrs

A

intussusception

116
Q

severe pain w/ peristalsis / vomiting / blood in rectum||anemia|dehydration|leukocytosis

A

intussusception

117
Q

classic signs of intussesception

A

vomiting|abdominal pain|rectal bleeding

118
Q

SA intussusception

A

oval pseudokidney appearing mass|non comp|target|thickened walls folded over each other

119
Q

refers to any variation in normal rotation and fixation of GI tract during deveoplment

A

midgut malrotation

120
Q

most common portsystemic collateral seen w/ midgut malroation?

A

Left gastric vein

121
Q

midgut malrotation is ass w/ malposition of

A

SMA and SMV

122
Q

SA midgut malrotation

A

reversed position SMA and SMV|flow reversal in left gastric vein

123
Q

third leading of death from cancer

A

colon cancer - adenocarcinoma

124
Q

most common location of colon cancer

A

rectal carcinoma

125
Q

most common malignant tumor of GI tract

A

adenocarcinoma||-increased levels CEA

126
Q

gastric tumors arise in

A

pre-pyloric|antrum|lesser curve

127
Q

SA adenocarcinoma

A

solid intraluminal mass carying echo

128
Q

endoscopic sonography

A

7.5 MHZ|LLD|used to localize / characterize benign masses|staging esophageal cancer|differentiating astric lymphoma from carcinoma

129
Q

transrectal US

A

LLD/ LITHOMY|enema|staging rectal cancer

130
Q

primary or widespread|nodular . ulcerative/ infiltrating|common in AIDS patients

A

lymphoma

131
Q

SA lymphoma

A

large hypoechoic ulcerated masses|in stomach or small bowel|gas artifact

132
Q

mets

A

breat lung and melanoma

133
Q

SA mets

A

multiple small ulcerated nodules|hard to differ from primary

test (5 decks)

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