GI Flashcards
What is Gastroschisis?
Extrusion of abdominal contents through abdominal folds that is NOT covered by peritoneum
What is an omphalocele?
Persistence of herniation of abdominal contents into the umbilical cord that is SEALED by peritoneum—caused by a lack of regression of abdominal contents back into the abdominal cavity
What is the embryological derivative of the pharynx to the duodenum?
Foregut
What is the adult derivative of the midgut?
duodenum to proximal 2/3 of colon
What is the adult derivative of the hindgut?
Distal 1/3 of transverse colon to just above the pectinate line
Rostral fold closure defect = ?
Sternal defects
Failure of lateral fold closure = ?
Omphalocele, gastroschisis
Failure of caudal fold closure = ?
Bladder exstrophy
What is the cause of duodenal atresia? What genetic defect is this associated with?
Failure to recanalize–trisomy 21
What are the causes of jejunal, ileal, and colonic atresia?
Vascular accident
When in development does the midgut herniates through the umbilical rings? Return? When is returns, what artery does it rotate about?
6th week
10th
SMA
The intestines wrap around what artery in development?
SMA
What is the most common tracheoesophageal anomalies?
EA with distal tracheoesophageal fistula
What is the clinical test for assessing for a tracheoesophageal fistula?
Passing an NG tube down
What is the classic PE finding of congenital pyloric stenosis? S/sx?
Olive mass in the epigastric region
Non-bilious vomiting at 2-6 weeks old
What are the retroperitoneal organs (remember the mnemonic!)
Suprarenal
Aorta and IVC
Duodenum
Pancreas Ureters Colon (ascending and descending) Kidneys Esophagus Rectum
Is the pancreas derived from the foregut, midgut, or hindgut?
Foregut
What is annular pancreas?
When the pancreas wraps around the duodenum
What is pancreatic divisum?
When the ventral and dorsal parts of the pancreas fail to fuse at 8 weeks
What does the falciform ligament connect? What does it contain? What is it a derivative of?
- Liver to anterior abdominal wall
- Ligamentum teres hepatis (derivative of fetal umbilical vein)
- Derivative of ventral mesentery
What does the hepatoduodenal ligament connect? What does it contain? (3)
- Liver to the duodenum
- Portal triad: proper hepatic artery, portal vein, common bile duct
What is the pringle maneuver, and when is it used?
Compression of the hepatoduodenal ligament in omental foramen to control bleeding
What does the gastrohepatic ligament connect? What does it contain?
- Liver to lesser curvature of the stomach
- Gastric arteries
What does the gastrocolic ligament connect? What does it contain?
- Greater curvature and transverse colon
- Gastroepiploic arteries
What does the gastrosplenic ligament connect? What does it contain?
- Greater curvature of the stomach and the spleen
- Short gastric, left gastroepiploic arteries
What does the splenorenal ligament connect? What does it contain?
- Spleen to the posterior abdominal wall
- Splenic artery and vein
What are the layers of the GI tube, from deep to superficial?
Mucosa
Submucosa
Muscularis externa
Serosa
What is the role of the myenteric plexus?
Muscular motility
What is the role of the submucosal plexus?
Control of secretory activity
What is the difference between an ulcer and an erosion of the GI tract?
Ulcer = extend into the submucosa Erosion = in the mucosa layer only
Where in the gastric pits are parietal cells located? Chief cells?
Parietal cells near the top of the lumen
Chief cells near the bottom
Where are the crypts of lieberkuhn? What do these contain?
In the duodenum, jejunum, and ileum
Brunner’s glands
Where are peyer’s patches located?
Ileum
Which part of the small intestines has the greatest number of goblet cells?
Ileum
What is the parasympathetic innervation of the foregut, midgut, and hindgut?
Vagus, vagus, and pelvic splanchnic nerves
What spinal level is the celiac trunk located at?
T12
What spinal level is the SMA located at?
L1
What spinal level is the bifurcation of the aorta located at?
Bi-FOUR-cation (L4)
What is the breakdown of the innervation and arterial supply to the GI tract?
Pharynx to proximal duodenum
Distal duodenum to proximal 2/3 of colon
Remainder
What, generally, do the arteries that branch off of the aorta laterally supply? Anteriorly?
Anteriorly = GI organs Laterally = non-GI organs
What is SMA syndrome?
When the transverse portion of the duodenum is entrapped between the SMA and aorta, causing a SBO
What are the 3 main branches of the celiac trunk?
Splenic
Common hepatic
Left gastric
What does the common hepatic artery give rise to?
Proper hepatic
Gastroduodenal artery
True or false: there is a strong anastomosis between the right and left gastroepiploic arteries
True
True or false: there is a strong anastomosis between the right and left gastric arteries
True
The right gastroepiploic artery is a branch of what artery? Left?
Right = Gastroduodenal artery Left = Splenic
If branches off of the abdominal aorta are blocked, the superior epigastric artery anastomosis with what other artery to compensate? What is this a branch of?
Inferior epigastric (external iliac)
If branches off of the abdominal aorta are blocked, the superior pancreaticoduodenal artery anastomosis with what other artery to compensate? What is this a branch of?
Inferior pancreaticoduodenal (SMA)
If branches off of the abdominal aorta are blocked, the middle colic artery anastomosis with what other artery to compensate? What is this a branch of?
Left colic (IMA)
If branches off of the abdominal aorta are blocked, the superior rectal artery anastomosis with what other artery to compensate? What is this a branch of?
Middle and inferior rectal (internal iliac)
What is the anastomosis that allows the the development of esophageal varices in the case of cirrhosis?
Left gastric and esophageal
What is the anastomosis that allows the the development of caput medusae in the case of cirrhosis?
Paraumbilical and small epigastric veins
What is the anastomosis that allows the the development of anorectal varices in the case of cirrhosis?
Superior rectal and middle/inferior rectal
What is TIPS in the treatment of pHTN 2/2 cirrhosis?
Transjugular intrahepatic portohepatic shunt
The pectinate line is where what two embryological layers meet?
Endorem of the hindgut and ectoderm
What is the arterial supply and lymphatic drainage above the pectinate line?
Superior rectal arteries (IMA)
Deep nodes
What is the arterial supply and lymphatic drainage below the pectinate line?
Inferior rectal artery (branch of the pudendal)
Inguinal nodes
What hepatic zone is affected first with viral hepatitis? EtOH? Drug abuse? Ischemia?
Viral hepatitis and drugs - zone 1
EtOH and ischemia = zone 3
What hepatic zone houses the p450 enzymes?
3
What are the contents of the femoral triangle?
Femoral vein, artery, and nerve
Which of the following is not found in the femoral sheath: Femoral vein, artery, and/or nerve?
Femoral nerve
What is the ampulla of vater?
Exit of the pancreatic duct
What is the sphincter of Oddi?
Sphincter around the ampulla of vater
What is the pyramidalis muscle?
a small and triangular muscle, anterior to the rectus abdominis, and contained in the rectus sheath.