GI Flashcards
what structure contains the ligamentum teres hepatis?
falciform ligament
what structure contains the portal triad?
hepatoduodenal ligament
what is the portal triad?
hepatic artery, portal vein, common bile duct
what structure connects the greater and lesser omentum sacs?
hepatoduodenal ligament
what structure contains the gastric arteries?
gastrohepatic ligament (liver to LESSER CURVATURE of stomach) - cut during surgery to access lesser sac
what structure contains the gastroepiploic arteries?
gastrocolic ligament (GREATER CURVATURE and transverse colon) - part of GREATER omentum
what structure contains short gastric and left gastroepiploic vessels?
gastrosplenic ligament (GREATER curvature + spleen)
what structure separates the greater and lesser sacs on the right?
gastrohepatic
what structure separates the greater and lesser sacs on the left?
gastrosplenic
what structure contains the splenic artery and vein, and tail of the pancreas?
splenorenal
ulcers can extend to?
submucosa
erosions can extend to?
mucosa only (epithelium, lamina propria, muscularis mucosa)
this part of the pancreas is formed from the VENTRAL bud alone
uncinate process
pancreas derived from?
foregut
ventral pancreatic buds form?
inferior/posterior part of head
main pancreatic duct of Wirsung
uncinate process
dorsal pancreatic buds form?
body tail isthmus accessory pancreatic duct MOST of head
third part of duodenum trapped b/w?
aorta and SMA
only duodenal part not retroperitoneal?
1st
2nd part of duod in ass w/?
head of pancreas (ampulla of Vater)
3rd part of duod in ass w/?
uncinate process of pancreas
SMA/SMV
RF for increased incidence of cholangiocarcinoma
primary sclerosing cholangitis
infection w/ Clonorchis sinenus
ulcerative colitis
carcinoid synd produces what?
high levels of serotonin
when is carcinoid synd not seen?
if limited to GI tract (bc serotonin undergoes first-pass metab in liver)
sympt of carcinoid synd
recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease
dx/tx of carcinoid synd
**increased 5-HIAA (metabolite of serotonin) in urine
niacin deficiency
tx = octreotide (somatostatin analog)
window period in Hep B?
when HbsAg is (-), AND HbsAb (-), but HbcAb (+)
virchow’s node involves the
left supraclavicular node (mets from stomach)
sister mary joseph nodule involves
subcut periumbilical metastasis
what PUD causes pain w/ eating?
gastric ulcer
what PUD causes relief w/ eating?
duodenal ulcer
bleeding from what artery w/ ruptured gastric ulcer on lesser curvature?
left gastric artery
bleeding from what artery w/ ulcer on posterior wall of duodenum?
gastroduodenal artery
most common stomach cancer
adenocarcinoma
ligaments cut when removing spleen
gastrosplenic + splenorenal ligaments
arterial supply/venous drainage above pectinate line (proximal)?
A: superior rectal artery (branch of IMA)
V: superior rectal vein –> inferior mesenteric vein –> portal system
hemorrhoid/cancer seen above pectinate line?
internal hemorrhoid - NOT painful (bc visceral innerv)
adenocarcinoma
arterial supply/venous drainage below pectinate line (distal)?
A: inferior rectal artery (branch of internal pudendal artery)
V: inferior rectal v. –> internal pudendal v. –> internal iliac v. –> IVC
hemorrhoid/cancer seen below pectinate line?
external hemorrhoid - painful! (bc somatic innerv - inferior rectal branch of pudendal n.)
squamous cell carcinoma
autoimmune gastritis located in what part of stomach?
fundus/body
H.pylori chronic gastritis located in what part of stomach?
antrum
Mallory bodies typically seen w/?
alcoholic hepatitis
triad of Budd-Chiari synd
hepatomegaly
ascites
abdominal pain
cholelithiasis is
gallstones
cholecystitis is
inflamm/infection of GB
cholangitis is
inflamm/infection of biliary tree
choledocholithiasis is
gallstones in bile ducts
area of colon most suscept to infarction?
watershed area of splenic flexure
hereditary hyperbilirubinemia responding to phenobarbitol
Crigler-Najjar type II
Gilbert synd
bc increases liver enzyme synth
hereditary hyperbilirubinemia w/ black liver
Dubin-Johnson synd
air seen in GB and biliary tree a sign of?
cholecystenteric fistula leading to gallstone ileus (stone stuck in ileocecal valve)
level of celiac trunk
T12
level of SMA
L1
level of LEFT renal artery
L1
level of IMA
L3
level of bifurcation of aorta
L4
receives blood from both SMA + IMA
splenic flexure (watershed area) first affected in hypotension
the 4 anastomoses + origins
sup epigastric (internal thoracic/mammary) inf epigastric (external iliac)
sup pancreaticoduod (celiac) inf pancreaticoduod (SMA)
middle colic (SMA) inf colic (IMA)
sup rectal (IMA) middle + inf rectal (internal iliac)
3 portal systemic shunts
forms varices!
1) left gastric v. esophageal v.
2) paraumbilical v. superficial and inf epigastric v. (BELOW umbilicus), sup epigastric and lateral thoracic v. (ABOVE umbilicus)
3) sup rectal middle + inf rectal
rectal drainage above + below pectinate line
above: sup rectal v. –> IMV –> portal system
below: inf rectal v. –> internal pudendal v. –> internal iliac v. –> IVC
zone I of liver
affected 1st by viral hepatitis
zone III of liver
pericentral vein zone
- affected 1st by ischemia (bc farthest from O2 blood)
- contains P450 system
- most sensitive to toxic inj (acetaminophen OD, alc tox)
- site of alcoholic hepatitis
blood flows from
zone 1 –> 3
bile flows from
zone 3 –> 1
tumor of pancreatic head blocks
common bile duct ONLY
diaphragmatic hernia in infants can be due to
defective dev’t of pleuroperitoneal membrane
potent gastrin stimulators
phenylalanine
tryptophan
Calcium
bile acids conjugated to what substances?
glycine or taurine
rate-limiting enzyme in bile prod
cholesterol 7alpha-hydroxylase
bilirubin conjugated to what to make soluble?
glucuronic acid
tx of esoph varices
vasopressin
duodenal ulcer perforation usually in
anterior > posterior
rectal SPARING
Crohn’s!
continuous lesions w/ RECTUM ALWAYS involved
UC
unique ass w/ Crohn’s (vs. UC)
migratory polyarthritis
erythema nodosum
kidney stones
strictures
unique ass w/ UC (vs. Crohn’s)
pyoderma gangrenosum (tissue necrosis causing deep ulcers)
primary sclerosing cholangitis
toxic megacolon
colorectal cancer presenting w/ Fe-def anemia is located where
ascending
tx for ulcer hemorrhages
somatostatin (octreotide) - bc decreases splanchnic blood flow
microvesicular fatty change
Reye’s synd
macrovesicular fatty change
hepatic steatosis (mod alc intake)
why is AST»_space; ALT in alcoholic hep?
bc B6 def decreases ALT
centrilobular congestion + necrosis
halogenated inhalation anesthetics injury
nutmeg liver
Budd-Chiari
cirrhosis w/ PAS positive globules in liver
alpha1-antitrypsin def
tx for physiological neonatal jaundice?
phototherapy (converts UCB to water soluble form)
tx of PBC
ursodiol
black pigment stones
ass w/ hemolysis
radiopaque (white)
brown pigment stones
ass w/ infection
radiolucent (black)
air in biliary tree ass w/
cholecystenteric fistula in SI (b/w GB and SI) gallstone ileus (stone obstructing ileocecal valve)
positive Murphy’s sign usually in
cholecystitis
charcot’s triad of cholangitis? Reynold’s pentad?
triad - jaundice, fever, RUQ pain
pentad - triad + hyPOtension, altered mental status
pancreatic pseudocyst = complic of what? and lined by?
acute pancreatitis
lined by granulation tissue
signs of pancreatic cancer
- abd pain radiating to back
- wt loss
- Trousseau’s sign (migratory thrombophlebitis)
- Courvoisier’s sign (palpable, NONTENDER [aka painLESS] GB w/ obstructive jaundice)
