GI Flashcards
Where do the majority of the digestive enzymes enter the GI tract?
Duodenum (produced by the pancreas)
‘Cranio-sacral outflow’ relates to which part of the nerve supply to the gut?
Parasympathetic
What forms the lateral border of the femoral ring?
Femoral Vein (NAVEL)
What anatomical structure lies at the mid-point of the inguinal ligament?
Deep-inguinal ring (mid-inguinal point = half way between ASIS + pubic symphysis)
What is the location of the linea alba?
Vertical in the midline from xiphoid process to pubic symphysis
What type of hernia might be precipitated by a weakend conjoint tendon?
Direct inguinal hernia
(tendon lies behind superficial inguinal ring on the posterior wall)
Which hormone is stimulated by fatty acids and amino acids and then causes the pancreas to produce digestive enzymes?
Cholecystokinin (CCK)
The portal vein is commonly formed when which 2 large veins come together?
Superior mesenteric vein + splenic vein
Which stage of alcoholic liver disease does not give you hepatomegaly?
Cirrhosis (reduces in size)
Which vessel if blocked or narrowed would cause portal hypertension and why?
Hepatic Veins
(these are distal to the portal vein and so if blocked would limit the flow through the portal vein and cause a rise in portal pressure)
(other vessels drain into the portal vein)
Cancer arising in what location in the pancreas can result in the patient becoming jaundice and why?
The Head
(will block the common bile duct)
Where in the colon would a cancer most likely result in a bowel obstruction?
Sigmoid colon
- contents is more solid as water has been reabsorbed so more likely to cause obstruction
- grow circumferentially around bowel lumen
Which condition is associated with the development of adenomas?
Familial Adenomatous Polyposis (FAP)
Which bacteria could cause pseudomembranous colitis? (raised yellow plaques in large bowel)
Clostridium difficile
What is the difference between Norovirus and Rotavirus?
Norovirus symptoms can appear in both adults and children. As it has many different strains so can’t build immunity.
Rotavirus only symptomatic in children.
The greater sac is divided into supracolic and infracolic compartments. What structure divides these?
Transverse Mesocolon
At what spinal level does the oesophagus enter the abdomen?
T10
(oesophagus has 10 letters)
Where does the hepatic portal vein usually originate?
Behind the neck of the pancreas at the confluence of the splenic vein and superior mesenteric veins.
Which 2 x blood vessels and 1 x duct lie in the free edge of the lesser omentum?
Hepatic artery
Hepatic portal vein
Common bile duct
What double fold of peritoneum connects the stomach to the liver?
Lesser omentum
An abdominal wall hernia can pass through a defect in which structure?
Transversalis fascia
(indirect hernia - deep ring)
What section of the GI tract is the appendix located?
Caecum (start of LI)
What is the longest section of the GI tract?
Ileum
Where do parasympathetic pre-ganglion fibres synapse in the gut?
Visceral wall
What are the borders of Hesselbach’s triangle?
Lateral border - Inferior epigastric vessels
Medial border - Lateral border of rectus abdominus
Inferior border - Inguinal ligament
(IL, EL, MAR)
Describe the pharyngeal phase of swallowing?
Involuntary
1. Soft palate seals off nasopharynx
2. Pharyngeal constrictors push bolus down
3. Larynx elevates to close epiglottis
4. Vocal cords adduct to protect airway
(breathing temporally stops)
5. UOS opens
Which gram -ve bacteria has the longest incubation period that causes food poisoning?
Campylobacter (1-7 days)
Why can appendicitis be felt in the RIF?
The inflamed appendix irritates the parietal peritoneum
Which IBD causes narrowing on a barium swallow?
Chron’s (full thickness of bowel wall)
A 70 year old man presents with sudden onset colicky abdo pain coming on every 15 mins. Unable to pass faeces but isn’t vomiting. What is causing his bowel obstruction?
Sigmoid volvulus
Which part of the stomach is most prone to ulcers?
Lesser curve
Which artery sits behind the body of the stomach?
Splenic artery
Which blood test would be raised in a patient with a gallstone stuck in the CBD?
Conjugated bilirubin levels
What type of hernia would be caused by a weakened conjoint tendon and why?
Direct inguinal ligament
(medial part of posterior wall)
What’s the difference between the inner and outer muscularis?
Inner CIRCULAR muscle (get’s longer)
outer LONGITUDINAL muscle (get’s narrower)
What is the difference between a gallstone in the proximal CBD and distal CBD?
Proximal - ascending cholangitis
Distal - pancreatitis (blocks CHD)
(Both show post-hepatic jaundice)
How does alcoholic steatosis (fatty liver) occur?
A byproduct of alcohol metabolism is NADH which inhibits lipid breakdown
Ethanol inhibits the formation and secretion of lipoproteins (so lipids accumulate in the liver)
Why does chronic alcohol misuse
lead to malnutrition and vitamin deficiencies?
Alcohol related chronic gastritis (impaired digestion/release of IF)
Pancreatitis (impaired release of digestive enzymes)
Intestinal mucosal damage (impaired absorption/digestion)
Intake of alcohol replacing calories from diet
How does alcohol abuse cause varices?
- Chronic alcohol abuse has led to cirrhosis
- Cirrhosis has led to portal hypertension (as portal vein
drains through liver) - Portal hypertension has created a back pressure on veins draining through liver, including oesophageal veins
- Oesophageal veins form the portal section of the portosystemic anastomosis in the oesophagus responsible for varices
What are the 3 locations for varices?
Oesophageal
Anus
Umbilicus (medusa)
What are some perianal diseases present in Chron’s?
Anal fissure
Haemorrhoids
Skin tags
Perianal abscess
Opening of a fistula
Explain why the right lower quadrant is a common site for
abdominal pain and tenderness in Crohn’s disease?
The most common site of involvement in Crohn’s disease is the ileocaecal region
Why do post hepatic jaundice patients have dark urine?
In post-hepatic jaundice the liver is able to process the conjugation of bilirubin so bilirubin is soluble
However there is a blockage of flow of bile into the gut so plasma bilirubin levels rise
As the bilirubin is soluble it can be excreted by the kidneys and the bilirubin gives the urine a dark colour
