GI Flashcards
foregut becomes
esophagus to 2nd part of duodenum
midgut becomes…
upper duodenum to proximal 2/3rds transverse colon
hindgut becomes..
distal 1/3rd transverse colon to anal canal above pectinate
when does midgut start rotating and until when
midgut physiologic herniation through UMBILICAL RING at week6 and 270 deree counterclockwise rotation around SMA by week 10
rostral fold closure failure leads to
sternal defects (ectopia cordis)
lateral food closure failure leads to
gastroschisis and omphalocele
caudal fold closure failure leads to
bladder extrophy
most common tracheoesophageal anomaly
esophageal atresia with distal TEF
air enters stomach, vomits with FIRST feeding
double bubble sign associated with down syndrome
duodenal atresia
what does jejunal and ileal atresia lead to
disruption of mesenteric vessels, ischemic necrosis, and segmental resorption (bowel discontinuinity and “apple ppel”
pancreas comes from foregut, midgut, or hindgut?
foregut
origin of pancreatic head
both ventral and dorsal pancreatic bud
origin of uncinate process, and main pancreatic duct
ventral pancreatic duct
origin of pancreatic boy, tail, isthmus, accessory pancreatic duct
dorsa lpancreatic duct
ring of pancreatic tissue that causes narrowing of duodenum
annular pancreas (encircles 2nd part of duodenum)
ventral and dorsal pancreatic tail fails to fuse at 8 weeks
pancreas divisum
mostly asymptomatic, but can cause chronic abdominal pain or pancreatitis
where does spleen arise and what blood supplies
spleen arises from mesentery of stomach (mesodermal) but is supplied by foregut (celiac trunk -> splenic artery)
what makes a GI structure retroperitoneal?
lacks mesentery
what are the retroperitoneal structures
SAD PUCKER suprarenal/adrenal glands aorta/ivc dudoenum (part 2-4) pancreas (everything but tail) ureters colon (ascending and descending parts) kidneys esophagus (thoracic) rectum
what part of duodenum has opening to CBD and pancreatic duct
2nd part
blood supply to foregut
celiac trunk
p and s supply of foregut
parasym - vagus nerve
symp - throacic splanchnic
p and s supply of midgut
para - vagus
symp - thoracic splanchnic
blood supply midgut
SMA
blood supply hindgut
IMA
p and s of hindgut
para - pelvic splanchnic
sym - lumbar splanchnic
besides esophagus and duodenum what else comes from foregut
pharynx, liver gallbladder, pancreas, spleen (tehcnically mesoderm) but gets blood supply from celiac
what is contained in falciform ligament (comes from ventral mesentery)
ligamentum teres hepatis (fetal umbilical vein derivative)
what is contained in hepatoduodenal ligament
portal triad (proper hepatic, common bile duct, portal vein)
what is the pringle manuever
squeezing the hepatoduodenal ligament to control bleeding in omental foramen
which ligament contains gastric arteries
gastro hepatic ligament
what houses the gastro epiploic arteries
gastrocolic ligament
what is contained within splenorenal ligament
splenic artery and vein, tail of pancreas
layers of gut wall from inside to outside
MSMS mucosa submucosa muscularis serosa
which layer of gut wall contains messner nerve plexus and secretes fluid
submucosa
which layer contains myenteric nerve plexus (auerbach) and is responsbile for motility
muscularis
gastric erosion vs gastric ulcer
erosion only affects mucosa
ulcer can invade into submucosa, inner or outer muscular layer
difference in functio between auerbach and meissner’s plexus
meissner plexus (submucosal) only has parasympathetic tone (secretory) whereas auerbach has both
what type of cells reside in esophagus
nonkeratinized stratified squamous
histology of stomach
gastric glands
what are brunner glands and where are they located
hco3 secreting cells of submucosa located in duodenum
location and function of crypts of liberkuhn
contain stem cells that repalce enterocytes/goblet cells and Paneth cells that secrete defensins, lysozyme and TNF) located in duodenum and jejunum
where are peyer patches located
ileum, jejunum lacks these
which has more plicae circularis jejunum or ileum
jejunum
nutcracker syndrome
sandwiching of L renal vein between SMA and aorta…varicocele
intermittent intestinal obstruction (primarily postprandial) when transverse protaon of duodenum is compressed between SMA and aorta
superior mesenteric artery syndrome
low body weight and weight/malnutrition
complication of posterior duodenal ulcer
penetrate gastroduodenal artery and cause hemorrhage
complication of anterior duodenal ulcers
peprforate into anterior abdominal cavity and cause pneumoperitoneum
three branches of celiac artery that supplies stomach
common hepatic, left gastric, splenic
what portion of stomach does splenic artery supply
fundus and half of body via short gastric and left gastroepiploic
what portion of stomahc does left gastri supply
cardia and part of lesser curvature
how does common hepatic artery supply stomach
branches into right gastric to supply bottom part of lesser curvature and branches into gastroduodenal which branches into right gastroepiploic to supply bottom part of fundus *that isn’t suppled by left gastroepiploic
which stomach arteries have strong anastomoses
left and right gastroepiploics
left and right gastrics
portal and systemic anast at esophagus
left gastric and azygosvein
portal systemic anast at umbilicus
paraumbilical to small epigastric veins of atnerior abdominal wall
portal systemtic anast at rectum
superior rectal to middle and inferior rectal
portal hypertension sign at umbilicus
caput madusae
significance of pectinate line
formed where endoderm (hindgut) meets ectoderm
borders of femoral triangle
inguinal ligament (superiorly), adductor longus, sartorius laterally
cellular component in charge of vascular remodeling and invading basement membraines (tumors)
metalloproteinases
what defends against local vs systemic candidiasis
local - t lymphocytes
systemic - neutrophils
main cause of cluadication
atherosclerosis of larger named arteries which cause fixed stenotic lesions caused by atheromas (lipid filled intimal plaques that bulge into lumen)
recurrent apthous ulcers, genital ulcers, uveitis
behcet syndrome often seen after viral infection
vesicles in oral mucosa that rupture and result in shallow painful red ulcers
hsv1
usually occurs in childhood
where does HSV1 remean latent
can remain dormant in ganglia of trigeminal nerve and can cuase reactivation later in life (cold sores)
major risk factor for sqamous cell carc
tobacco and alcohol
most common location in oral mucosa
floor of mouth
precursor lesions to squamous dysplasia in oral mucosa
leukoplakia and erythroplakia (cannot be scraped away)…more toward ERYTHROPLAKIA FOR CANCER
rough shaggy patch in LATERAL TONGUE
hairy luekoplakia
associated with EBV CAN BE scraped off
inflamed parotid glands bilaterally
mumps
can also develop orchitis
what lab value is elevated in mumps
serum amylase (can also indicate pancreatic involvement) as well as salivary amylase
feared complications of mumps
orchitis, pancreatitis, aseptic meningitis
inflammation fo salivary gland due to obstructing stone
sialadentiisi
most common organism in siladenitis
staph aureus
mcc tumor of salivary gland
pleomorphic adenoma (benign) stromal and epithelial tissue mix…is mobile painless and circumscribed at angle of jaw
rate of recurrence on pleomorphic adenoma
high rate of reccurence
because surgical resection isn’t complete often time
sign of malignant transformation of parotid mass
turns painless into painful (indicates malignant invasion of facial nerve)
benign cystic tumor with abundant lymphocytes and germinal centers
warthrin tumor
2nd most common tumor of salivary gland
warthrin tumor
cystic tumor with lymphoid tissue
malignant tumor composed of mucinous and squamous cells
mucoepidermoid carcinoma, can involve facial nerve
hx of gallstones, presents with SBO and air in gallbladder and biliary tree
gallstone ileus due to cholecystenteric fistula with stone now lodged in ILEUM (narrowest part of small intestine)
if pringle manuver is performed and bleeding doens’t stop…where is source of bleeding
hepatic vein or IVC
vomiting on first feed, polyhydramnios, abdominal distention, aspiration
TE fistula
beefy red tongue, esophageal web, ida
plummer vinson
dysphagia, obstruction, halitosis
zenker diverticulum (outpouching of pharyngeal mucosa through acquired muscular wall defect…usually affects upper esophageal sphincter at junction of esophague and pharynx)
longitudinal linear laceration of mucosa at GE junction
mallory weiss syndrome
seen in frequent vomiting/alcoholics
painful hematemesis
mallory weiss syndrome
rupture of (mediatinal air into esophagus, subcutaneous emphysema and crepitus)
boerhaave
painless hematemsis in portal hypertension
bleeding varices (most common cause of death)
achalasia results from damge to what nerves
ganglion cells in myenteric plexus
causes disordered esophageal motility and inability to relax
infection that cuases achalasia
chagas
achalasia gives increased risk for what cancer
esophageal squamous cell carcinoma
transformation of cells in GERD
go from nonkeratinizing squamous epithelium to nonciliated columnar cells with goblet cells
bowel sounds in lower lung field
paraesophageal hernia
not assocaited with GERD
but risk of lung hypoplasia
hourglass stomach
sliding hiatal hernia, assocaited with GERD
malignant proliferation fo glands in esophagus
adenocarcinoma (from Barrett’s esophagus) MCC esophageal carcinoma in west
what portion of esophagus is adeno and squamous
adeno- lower 1/3rd
squamous - upper 2/3rds
risk factors for squamous cell carcinoma
anything that causes IRRITATION
alcohol, tobacco, hot tea, achalasia, esophageal webs, esophageal injury
what hair chemical product can cause esophageal irritation
lye
progressive dysphagia, weight loss, pain , hematemesis
esophageal cancer
which lymph nodes supply upper, middle, and lower thirds of esophagus
upper - cervical
middle - mediastinal/tracheobronchial nodes
lower - celiac/gastic nodes
what runs over 3rd part of duodenum
SMA
hx chronic pancreatitis presents with gastric varices without esophageal varices…which vessel involve
splenic vein
spleniv vein thrombosis can be seen in chronic pancreatitis
