GI Flashcards
Histology of esophagus
Nonkeratinized stratified squamous epithelium.
Histology of stomach
Gastric glands.
Histology of duodenum
Villi and microvilli
Histology of jejunum
Plicae circulares and crypts of Lieberkühn.
Histology of ileum
Peyer patches (lamina propria, submucosa), plicae circulares (proximal ileum), and crypts of Lieberkühn.
Largest number of goblet cells in the small intestine.
Histology of colon
Colon has crypts of Lieberkühn but no villi; numerous goblet cells.
What is zone I of the liver?
Zone I: periportal zone:
- Affected 1st by viral hepatitis
- Ingested toxins (e.g., cocaine)
What is zone II of liver?
Zone II: intermediate zone.
What is zone III of liver? what is is significant about this area?
Zone III: pericentral vein (centrilobular) zone:
- Affected 1st by ischemia
- Contains cytochrome P-450 system
- Most sensitive to metabolic toxins
- Site of alcoholic hepatitis
What are the borders of Hesselbach triangle?
- Inferior epigastric vessels
- Lateral border of rectus abdominis
- Inguinal ligament
What are the functions of bile?
- Digestion and absorption of lipids and fat-soluble vitamins
- Cholesterol excretion (body’s only means of eliminating cholesterol)
- Antimicrobial activity (via membrane disruption)
elevated ALP
Obstructive hepatobiliary disease, HCC, bone disease
elevated Aminotransferases (AST and ALT)
Viral hepatitis (ALT > AST) Alcoholic hepatitis (AST > ALT)
elevated amylase
Acute pancreatitis, mumps
Low ceruloplasmin
Wilson disease
elevated γ-glutamyl transpeptidase (GGT)
elevated in various liver and biliary diseases (just as ALP can), but not in bone disease; associated with alcohol use
elevated lipase
Acute pancreatitis (most specific)
Name the retroperitoneal structures
SAD PUCKER: Suprarenal (adrenal) glands Aorta and IVC Duodenum (2nd through 4th parts) Pancreas (except tail) Ureters Colon (descending and ascending) Kidneys Esophagus (lower 2/3) Rectum (partially)
Name the connection & structures contained of the falciform ligament. What is it a derivative of?
connects liver to anterior abdominal wall
Contains ligamentum teres hepatis (derivative of fetal umbilical vein)
Derivative of ventral mesentery
Name the connection & structures contained of the hepatoduodenal ligament. What does it border?
Liver to duodenum
Portal triad: proper hepatic artery, portal vein, common bile duct
Borders mental foramen which connects greater & lesser sacs
Describe the pringle maneuver in relationship to hepatoduodenal ligament
ligament may be compressed bw thumb & index finger placed in mental foramen to control bleeding
Name the connection & structures contained of the gastrohepatic ligament. What does it separate? what is significant during surgery?
liver to lesser curvature of stomach
gastric arteries
separates greater & lesser sacs on right
may be cut during surgery to access lesser sac
Name the connection & structures contained of the gastrocolic ligament. What is this ligament a part of?
greater curvature & transverse colon
Gastroepiploic arteries
part of greater momentum
Name the connection & structures contained of the gastrosplenic ligament. What does it separate?
greater curvature & spleen
short gastrics, left gastroepiploic vessels
separates greater & lesser sacs on left
Name the connection & structures contained of the splenorenal ligament.
spleen to posterior abdominal wall
splenic artery & vein; tail of pancreas
Name the artery, PANS innervation, vertebral level & structures supplied by the embryonic foregut region
Artery: celiac
PANS: Vagus
Vertebral level: T12/L1
Structures supplied: Pharynx to proximal duodenum; liver, gallbladder, pancreas, spleen (mesoderm)
Name the artery, PANS innervation, vertebral level & structures supplied by the embryonic midgut region
Artery: SMA
PANS: Vagus
Vertebral level: L1
Structures supplied: Distal duodenum to proximal 2/3 of transverse colon
Name the artery, PANS innervation, vertebral level & structures supplied by the embryonic hindgut region
Artery: IMA
PANS: Pelvic
Vertebral level: L3
Structures supplied: Distal 1/3 of transverse colon to upper portion of rectum; splenic flexure is a watershed region
If branches off of the abdominal aorta are blocked, which arterial anastomoses compensate? (from origin)
Superior epigastric (internal thoracic/mammary) ↔ inferior epigastric (external iliac)
Superior pancreaticoduodenal (celiac trunk) ↔ inferior pancreaticoduodenal (SMA)
Middle colic (SMA) ↔ left colic (IMA)
Superior rectal (IMA) ↔ middle & inferior rectal (internal iliac)
Describe the transjugular intrahepatic portosystemic shunt (TIPS) Tx
shunt b/w portal vein & hepatic vein percutaneously relieves portal hypertension by shunting blood to the systemic circulation
What is the portal to systemic shunt w/ clinical sign of esophageal varices? Caput medusae? Anorectal varices (not internal hemorrhoids)?
Left gastric ↔ esophageal
Paraumbilical ↔ small epigastric veins of the anterior abdominal wall.
Superior rectal ↔ middle and inferior rectal
What is the most common cause of megaloblastic anemia?
chronic gastritis
