GI Flashcards
gastrochisis
extrusion of abdominal contents through abdominal fold - NOT COVERED BY PERITONEUM
omphalocele
percistence of hernation into umbilical cord - covered by peritoneum
most common traceoesophageal anomaly
esophageal etresia with distal trachalesophageal fistula (EA with TEF)
EA with TEF sx
droolingm chocking and vomiting with firstfeedinh
olive in epigastric region and nonbilious projectile vomiting at 2 weeks of age
congenitil pylor stenosis
falicform ligament connects
liver to anterior abdominal wall (old umbilical vein)
contained in hepatoduodenal ligament
hepatic artery, portal vein, common bile duct
pringle manuver
compressing hepatodual ligament between finger and thumb to in omantal foramen to control bleeding
inside to outside gut wall
mucosa to submucosa to muscularis to serosa
meissniers plexus in what layer
submucosa
myentric/auerbach’s plexis in
muscularis
submucosal plexus controls
secretion
crypts if leiberkuhn are in
jejunum, ilieum
most SI goblet cells
ilieum
blood /nerve supply to foregut
celiac /vagus
blood /nerve supply to midgut
SMA/vagus
blood /nerve supply to hindgut
IMA/pevlic
celiac branches off aorta at what level
t12/L1
SMA branches off aorta at what level
L1
IMA branches off aorta at what level
L3
foregut structures
stomach, prox duodenum, liver, gallbladder, pancreas, spleen
midgut structures
distal duodenum to proximal 2/3 transverse colon
hindgut structures
distal 1/2 transverse colon to upper rectum
branches of celiac trunk
common hepatic, splenic, left gastric
main blood supply of stomach
celiac trunk
strong anamoses in celiac trunk are between
left and gastroepiploics and left to righ gastrics
main arterial anamostes in Abominal aorta
superior pigastric (interior thoracic) to infierior epigastric (SMA) superior pancraticoduodenanl (celiac trunk) to inferior pancreatcduodenal (SMA) middle colic (SMA) to left colic (IMA) superior rectal (IMA) to middle and inferior rectal (internal iliac)
surgical tx for portal hypertension
transjugular intrahepatic portostystemic shunt (TIPS) between portal vein and heptic vein -shunts blood to systemic circulation
sites of portal anamostes
esophageal, umbilicus, rectum (sites of varaies in portal hypertension)
painful hemmoroid site
external
above pectinate line drains to
portal system/deep lymphatic nodes
below pecinate line drains to
IVC system/superficsial inginal nodes
first zone of liver affected by ischemia
zone III (pericentral vein/certiclobular) zone
first zone of liver affected by viral hepatitis
zone 1 (periportal) zone
apical surface of hepatocytes face
bile caniculi
basolateral surface of hepatocytes face
sinusoids
can block both bile and pancreatic ducts
gallstones that reach the common channel at the ampule of vater
tumors arising in head of pancreas can block
common bile duct
lateral to medial femoral structures
NAVL
femoral triangle contains
VAN
femoral sheath comtains
VAL
site of of femoral hernia
femoral ring
structures in superficsial ingunal ring (in to out_
internal spermatic fascia cremasteric muscle and fascia external spermatic fascia spermatic cord linea alba
most common hernia
hiatal
GE junction displaced into thorax
sliding hiatal hernia
fundus of stomach displaced into thoraz
paraesopgaheal hernia
hernia into the scrotum through deep/external inguinal ring and into scrotum
indirect inguinal hernia
hernia through inginal triangle through external inguinal ring only
direct inguinal hernia (common in old men)
most common hernia in women
femoral
leading cause of bowel incarceration
femoral
hernia medial to inferior epigastric artery
direct
hernia lateral to inferior epigastric artery
indirect
source/action of gastrin
G cells in antrum of stomach/increases gastic acid secretion, growth of gastric mucosa and gastric motility
source/action of cholecystokinin
I cells in duodenum/jejunum/ inreases pancreatic secretion and gallbladder contraction, delays gastric emptying
source/action of secretin
S cells in duodenum/ increases pancereatic bicarb/bile secretion. decreases gastric acid secretion
source/action of somastatin
decreases gastric acid, pepsinogen secretion,decrease pancreatic and SI fluid secretion, gallbladder contraction and insulin and glucagon relaase
releases/reduces gastrin
stomach distention, alkalization, amino acids, peptides, vagal stimulation/extra low stomach pH
releases colecystokinin
fatty acids and amino acids in stomach
releases secretin
acid, fatty acids in lumen of duodemum
releases/reduces somatostatin
acid/vagal stimulation
releases gastric insulinotropic peptide
fattyacids, amino acids, oral glucose
source/action of gastric insulinotropic peptide
PS ganglia in sphincters, gallbladder and SI/ releases intestinal water and electrolyte secretion, relaxes smooth muscle and sphincters
increased in zollinger-ellison
Gastin
amino acids that stimulate gastrin
phenylanaline and tryptophan
sx of VIPoma (non-a/non-b islet cell pancreatic tumor)
watery diarrha, hypokalemia, and achlorhydria
can increase lower esophageal sphincter
nitric oxide
stimulates intestinal peristalis
motillin (can use erythromycin)
saliva becomes more _____ with higher flow
isotonic (from hypotonic)
parietel cells secrete
intrinsic factor and gastric acid
chief cells secrete
pepsin
gastrin MOA
effects histamine release from ECL cells
peptic ulcer disease wil increase
brunner gland hypertrophy (secretes alkaline mucus in duodenal submucosa)
digests starches
a amylase
digests fats
lipases
secreted as zymogens by pancreas
proteases, trypsinogen
pancreatic enzyme that feeds back to increase it’s own release
trypsinogen
digests carbd
amylase, oligosaccharide hydrolases
rate limitiing step of carb digestion
oligosaccharide hydrolases
sugars absorbed by enterocyes
monosaccarides (fructose, galactose, glucose)
fructose taken up by
GLUT-5
glucose and galactose taken up by
SGLT1
iron absorped in
duodenum
folate absorbed by
jejunum
B12 absorbed by
terminal ilieum (requires IF)
catylazes rate limiting step of bile production
cholesterol 7a hydroxylase
functions of bile
digestion/absorption of lipids and fat-soluable vitamins
cholesterol excretion
antimicrobial activity
excretes bilirubun
bile (bile, bile! Billurubin)
water soluable bilirubun
direct
liver does what to bilirubun
makes it direct (conjugates it)