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GI Flashcards

1
Q

gastroschisis

A

extrusion of abdominal contents through abdominal folds; no covering
failure of the fusion of lateral folds during transverse folding
right of the umbilical cord
gastRoschsis–Right

prematurity and vasoconstritive agents (cocaine)

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2
Q

exstrophy of bladder

A

caudal fold closure, anterior abdominal wall.

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3
Q

midgut development

A

6th week–herniation through umbilical ring
10th week-return to cavity, rotation around SMA
270 degrees.

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4
Q

midgut volvulus/malrotation

A

green puke, failure of midgut to complete 270 degrees into peritoneal cavity
C loop must be on right side (small intestine, cranial limb) and the caudal limb (large intestine to the left).
caudal limb rotates addition 180 degrees inside, cecum returning last
formation of Ladd bands–malrotation

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5
Q

duodenal atresia

A 
double bubble sign 
polyhydroaminos 
low intestinal reabsorption of amniotic fluid .
failed recanalization of duodenal lumen
annular pancreas (Ladd bands)
trisomy 21. 
bilious vomiting.
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6
Q

H type fistula

A

still some connection, not as severe. gasless abdomen

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7
Q

EA with distal TEF

A

most common. blind end esophagus (esophageal atresia). drooling, choking, and vomiting with first feeding. air enters the stomach. cyanosis
failure to pass NG tube into stomach

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8
Q

Pyloric stenosis

A

marked hypertrophy and hyperplasia of 2 muscular layers of pylorus
palpable “olive” mass in epigastric region
nonbilious projectile vomiting.
hypokalemic hypochloremic metabolic alkalosis.
male first born
correct dehydration first
pyloromyotomy
hungry vomiter

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9
Q

Annular pancreas

A

ventral pancreatic bud abnormally encircles 2nd part of duodenum
may cause duodenal narrowing

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10
Q

Hirschprung’s disease

A

absence of ganglion cells in the distal bowel.
failure of differentiation and migration of neural crest cells
neurocristopathy
functional bowel obstruction with dilation of proximal bowel.
failure to pass meconium, constipation, abdominal distension
RET gene
increase risk with down syndrome
Hirschsprung is a giant spring that has SPRUNG in the colon.

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11
Q

imperforate anus

A

urorectal septum fails to completely separate hindgut
VACTRAL
(tet, ASD, VSD)
(esophageal atresia, duodenal atresia, Hirschprung)
(VCUR, Renal Agenesis)
Vertebral

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12
Q

Falciform ligament

A

liver to anterior abdominal wall

fetal umbilical vein–ligament teres hepatis

ventral mesentary

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13
Q

hepatoduodenal ligament

A 
liver to duodenum
borders the omental foramen, which connectrs greater and lesser sacs
portal triad:
proper hepatic artery
portal vein 
common bile duct
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14
Q

gastrohepatic ligament

A

liver to lesser curvature of stomach
gastric arteries
separates greater and lesser sacs on the right. cut to access lesser sac

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15
Q

gastrocolic ligament

A 
greater curvature to transverse colon
gastroepiploci arteries
part of greater omentum
loose connective tissue
free fold of visceral peritoneum clinically important in that it adheres to sites of inflammation limiting damage to abdominal cavity.
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16
Q

gastrosplenic ligament

A

greater curvature and spleen
short gastrics, left gastroepiploic vessels
seperates greater and lesser sacs on the left

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17
Q

splenorenal

A

spleen to posterior abdominal wall
splenic artery and vein
tail or pancreas

18
Q

iluem histology

A 
peyer patches (lymphoid aggregates in lamina propria, submucosa) plicae circulares (proximal ileum), crypts of Leiberkuhn
largest # of goblet cells in small intestine
19
Q

blood supply/innervation to foregut

A

Celiac artery, vagus nerve, T12/L1.

pharynx (vagus) and lower esophagus (celiac) to proximal duodenum. liver, gallbladder, pancreas, and spleen

20
Q

branches of celiac trunk

A

splenic artery
left gastric artery–esophageal aa
common hepatic artery

21
Q

portal-systemic anastomosis

A

1)esophageal veins into left gastric veins (portal) or superiorly into azygous system (esophageal) (caval)
2) umbilicus–caput madusae, paraumbilical and epigastric veins of the anterior abdominal wall
3)rectum–anorectal varices. superior rectal (caval)from middle and inferior rectal (portal)
varices of gut, butt, and caput portal hypertension

22
Q

stomach blood supply

A 
left gastric (from ciliac... has esophageal branch..portal/caval anastomosis)
right gastric (from proper hepatic-->celiac) 
short gastric (-->splenic-->celiac)
left and right gastroomental(splenic-->celiac and gastroduodenal-->common hepatic-->celiac)
23
Q

SMA

A

vagus parasympathetics, L1
distal duodenum to proximal 2/3 of transverse colon
midgut
–>inferior pancreaticoduodenal artery (anastamosis with sup pancreaticoduodenal aa–>gastroduodenal–>from common hepatic–> celiac)
–>ileocolic and appendicular
–>right and middle colic
–>marginal artery

24
Q

diverticulitis

A

high internal pressure pockets with fecal matter in sigmoid colon

25
Q

pectinate line

A

above–internal hemmorhoids, superior rectal artery (IMA), portal drainage (superior rectal–>inferior mesenteric–>portal), visceral innervation(pelvics), not painful, internal iliac lymph nodes

below–external hemmorrhoids, fissures, squamous cell carcinoma
arterial supply–inferior rectal from internal pudendal
venous–inferior rectal–>internal pudendal–>internal iliac–>common iliac–>IVC
innervation–inferior rectal branch of pudendal nerve (somatic) painful, superficial inguinal nodes

26
Q

femoral region organizatoin

A

NAVEL
nerve artery vein empty lymphatics
lateral to medial to find your navel
femoral triangle– vein, artery, and nerve
sheath–vein, artery, canal (but no nerve)

27
Q

layers of spermatic cord from abdomen

A

external spermatic fascia (external oblique)
cremasteric muscle and fascia (internal oblique)
internal spermatic fascia (transversalis fascia)

28
Q

indirect vs direct hernia

A

deep inguinal ring–indirect, into the scrotum, infants, failure of processus vaginalis to close, covered by all 3 levels of fascia

direct-through hesselbach triangles. through abdominal wall, medial to inferior epigastric artery goes through external/superficial ring, covered by external spermatic fascia. MEDIAL.

MDs don’t LIe
medial direct
lateral indirect

29
Q

borders of hesselbach triangle

A

Inferior epigastric vessels
lateral border of rectus abdominis
inguinal ligament

30
Q

peyer patches

A

unencapsulated lymphoid tissue found in lamina propria and submucosa of ileum
contain specialized M cells that sample and present antigens to immune cells
B cells in germinal centers of Peyer patches

IgA secreting plasma cells, reside in lamina propria

31
Q

Bilirubin

A

heme oxygenase
heme–>biliverdin
unconjugated–liver, indirect, water insoluble
conjugated–bile, conjugated with glucuronic acid, more soluble
Gilbert syndrome—bilirubin to bilirubin diglucuronide problem, less than 20% conjugated.. (could be hemolysis)
increases in conjugated–liver specific disease

32
Q

perforation of duodenal ulcer

A

referred pain to the shoulder via phrenic nerve

33
Q

hemorrhage ulcer complication

A

posterior gastric/duodenal
gastric ulcer on less curvature— bleeding from less gastric artery
posterior duodenum–bleeding from gastroduodenal artery

34
Q

newborn jaundice

A

underdeveloped livers are not capable of appropriately processing bilirubin, phototherapy,
zz-ee

35
Q

severe newborn jaundice

A

mother Rh-, baby is Rh+. antibodies from mother cross the placental barrier and lyse RBCs of fetus.
mother processes excess bilirubin for kid before birth

RhoGAM to develop antibody to Rh antigen

36
Q

Meckel diverticulum

A

persistance of vitelline (omphalomesenteric) duct
secretion of gastric mucosa and/or pancreatic tissue
most common congenital anomaly of GI tract
2’s
2 inches long
2 feel from ileocecal valce
2% of population
first 2 years of life
2 types of epithelia

painless rectal bleeding or melena
most patients are aysmptomatic

37
Q

FAP

A

autosomal dominant of APC tumor suppressor on 5q
100% progress to CRC unless resection.
wnt signal, take away apc complex (polyubinquinates B-catenin), now B-catenin is stable, b-catenin goes to nucleus, transcription factor made.
latent signal

38
Q

Lynch syndrome

A

hereditary nonpolyposis colorectal cancer
autosomal dominant
mismatch repair genes–20x rate mutation, introduced during replication
microsatellite instability
proximal colon always involved
endometrial, ovarian, and skin cancers,
3 relatives with lynch syndrome-associated cancers across 2 generaltions, 1 of whom is diagnoses before age 50.
MLH1/MSH2

39
Q

hemochromatosis

A

chronic transfusion therapy
increase ferritin, increase iron, decrease TIBC, increase transferrin saturation.
HFE gene
phlebotomy or chelation therapy

40
Q

Omphalocele

A

abdominal contents into umbilical cord (epithelium). sealed by peritoneum. has covering
omphaloCELE–SEALed by peritoneum
persistance of midgut herniation
bowel and liver in amnion
more associated abnromalities than gastroschesis

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