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GI anatomy (335-344) Flashcards

1
Q

list the retroperitoneal structures

A 
"SAD PUCKER"
suprarenal glands (adrenals), Aorta and IVC, duodenum (2nd-4th parts), pancreas (except tail), ureters, colon (descending and ascending), kidneys, esophagus (lower 2/3), rectum
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2
Q

what connects the greater sac to the lesser sac

A

omental foramen (epiploic foramen of Winslow)

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3
Q

what does the falciform ligament connect

A

the falciform ligament connects the liver to the anterior abdominal wall

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4
Q

what is contained within the falciform ligament and what is the fetal derivative of this structure)

A

ligamentum teres hepatis (aka round ligament)

the ligamentum teres hepatis is the remnant of the fetal umbilical vein

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5
Q

what is the falciform ligament dervied from

A

ventral mesentery

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6
Q

what does the hepatoduodenal ligament connect

A

liver to duodenum

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7
Q

what structures are contained within the hepatoduodenal ligament

A

portal triad: proper hepatic artery, portal vein, common bile duct

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8
Q

what is the Pringle maneuver

A

the hepatoduodenal ligament is compressed between the thumb and index finger placed into the omental foramen to control bleeding
this is possible because the hepatoduodenal ligament runs right next to the omental foramen

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9
Q

what does the gastrohepatic ligament connect

A

liver to lesser curvature of the stomach

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10
Q

what is contained within the gastrohepatic ligament

A

gastric arteries

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11
Q

what does the gastrohepatic ligament separate

A

separates the greater and lesser sacs (on the right side of the stomach)

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12
Q

why might the gastrohepatic ligament be cut during surgery

A

to access the lesser sac

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13
Q

what does the gastrocolic ligament connect

A

greater curvature of the stomach to the transverse colon

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14
Q

what is contained within the gastrocolic ligament

A

gastroepiploic arteries

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15
Q

the gastrocolic ligament is part of what larger structure

A

greater omentum

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16
Q

what does the gastrosplenic ligament connect

A

greater curvature of the stomach to spleen

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17
Q

what is contained within the gastrosplenic ligament

A

short gastric and left gastroepiploic vessels

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18
Q

what does the gastrosplenic ligament separate

A

the greater and lesser sacs (on the left side of the stomach)

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19
Q

what does the splenorenal ligament connect

A

spleen to the posterior abdominal wall (peritoneum)

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20
Q

name the layers of the gut wall from inside to outside

A

mucosa,
submucosa,
muscularis externa,
serosa

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21
Q

what are the three components of the mucosa

A 
epithelium (for absorption), 
lamina propria (for support), 
muscularis mucosa (for motility)
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22
Q

what innervates the submucosa

A

Meissner’s plexus (sumucosal nerve plexus)

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23
Q

what innervates the muscularis externa

A

Auerbach’s plexus (myenteric nerve plexus)

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24
Q

what’s the difference between ulcers and erosions

A

ulcers can extend through the mucosa to the submucosa and inner or outer muscular layer;
erosions are in the mucosa only

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25
what frequency is the basal electric rhythm in the stomach? duodenum? ileum?
3 waves/ min 12 waves/ min 8-9 waves/ min
26
what histologically characterizes the esophagus
nonkeratinized stratified squamous epithelium
27
what kind of cell characterizes the stomach
gastric glandular cells
28
describe the intestinal wall morphology that characterizes the duodenum
Brunner glands and crypts of Lieberkuhn; | villi and microvilli
29
describe the wall morphology of the jejunum
``` plicae circulares (circular folds along the jejunum) and crypts of Lieberkuhn, villi and microvilli ``` note: very few Brunner's glands (duodenum) or Peyer's patches (ileum)
30
describe the wall of the ileum
``` Peyer patches (in the lamina propria and submucosa), plicae circulares (in the proximal ileum), crypts of Lieberkuhn, villi and microvilli ```
31
where is the largest number of goblet cells in the small intestines found
the ileum
32
describe the colon wall in terms of crypts, villi and goblet cells
crypts of Lieberkuhn NO villi numerous goblet cells
33
what is SMA syndrome
when the transverse (3rd) portion of the duodenum gets trapped between the SMA and the aorta the intestinal tract becomes obstructed
34
at what vertebral level does the aorta bifurcate into the common iliacs
L4 ("bifourcation")
35
list the arteries branching laterally off of the abdominal aorta from most superior to most inferior
1. inferior phrenic arteries 2. middle suprarenal arteries (superiors branch off the phrenics, inferiors branch off the renals) 3. renal arteries 4. testicular/ovarian (gonadal) arteries
36
list the vertebral levels for the celiac trunk, SMA, renal arteries, and IMA
celiac trunk: T12, SMA and renal arteries: L1 IMA: L3
37
what is the blood supply and parasympathetic innervation of the foregut
celiac artery and vagus
38
what structures comprise the foregut
pharynx to duodenum, pancreas, liver, gall bladder, spleen
39
what is the blood supply and parasympathetic innervation to the midgut
SMA and vagus
40
what is the blood supply and parasympathetic innervation to the hindgut
IMA and pelvic
41
what are the three branches of the celiac trunk
common hepatic, splenic and left gastric arteries
42
which arteries supplied by the celiac artery have strong anastomoses between them? which have poor anastomoses?
between left and right gastroepiploics and between left and right gastrics are strong short gastrics have poor anastomoses if splenic artery is blocked
43
what arterial anastomoses exist that can compensate for blockage of branches off the abdominal aorta
- superior epigastrics (from internal thoracic/mammary) inferior epigastrics (from external iliac) - superior pancreaticoduodenal (from celiac trunk) inferior pancreaticoduodenal (from SMA) - middle colic (from SMA) left colic (from IMA) - superior rectal (from IMA) middle and inferior rectal (from internal iliac)
44
what are 3 portosystemic anastamoses that can occur as a result of portal hypertension
1. left gastric esophageal => esophageal varices 2. paraumbilical veins epigastric veins of anterior abdominal wall => caput medusae 3. superior rectal middle and inferior rectal => anorectal varices
45
what anastamosis is created surgically as a treatment for portal hypertension
transjugular intrahepatic portosystemic shunt (TIPS) is created between portal vein and hepatic vein to shunt blood from portal system to systemic circulation
46
what two embryologic layers meet at the pectinate line
the endoderm (hind gut) and ectoderm
47
what kind of hemorrhoids are seen above vs. below the pectinate line
internal hemorrhoids above the pectinate line | external hemorrhoids below the pectinate line
48
how does blood get from the aorta to the rectum above the pectinate line? how does this blood drain back to portal system?
aorta--> IMA --> superior rectal artery superior rectal vein--> IMV--> portal system
49
how does blood get from the aorta to the rectum below the pectinate line? how does this blood drain back to portal system?
aorta--> internal iliac arteries--> internal pudendal arteries --> inferior rectal arteries inferior rectal veins--> internal pudendal veins --> internal iliac veins --> IVC
50
are internal hemorrhoids painful? | why or why not?
no; b/c they receive visceral innervation
51
where do the lymphatics of the rectum above the pectinate line drain to?
deep lymph nodes
52
are external hemorrhoids painful? | why or why not?
yes; they receive somatic innervation from inferior rectal branch of pudendal nerve
53
where do the lymphatics of the rectum below the pectinate line drain to?
superficial inguinal nodes
54
what is anal fissure and what symptoms does it cause
a tear in the anal mucosa below the pectinate line | Sx: pain while pooping, blood on toilet paper, located posteriorly since this area is poorly perfused
55
what surface of the hepatocytes face the sinusoids
basolateral
56
what surface of the hepatocytes face the bile canaliculi
apical (secrete bile out apical side)
57
describe the three zones of hepatic tissue
Zone 1: periportal zone Zone 2: intermediate zone (bile and blood flow in opposite directions) 3. Zone 3: pericentral (centrilobular) zone
58
which zone of hepatic tissue is first to be affected by viral hepatitis or acted on by toxins like cocaine
zone 1 (periportal zone)
59
which zone of hepatic tissue is first to be affected by ischemia
zone 3 (centrilobular)
60
which zone of hepatic tissue is the site of alcoholic hepatitis and contains CYP450
zone 3 (centrilobular)
61
where must a gallstone be in order to block both the bile duct and pancreatic duct
ampulla of Vater
62
tumor in what location commonly causes obstruction of the common bile duct
tumor in the head of the pancreas
63
name the vessels/nerves running through the femoral region (underneath the inguinal ligament) from lateral to medial
NAVEL: femoral Nerve, femoral Artery, femoral Vein, (empty), Lymphatics
64
what comprises the femoral triangle
femoral nerve, artery and vein
65
what is found within the femoral sheath
femoral artery, nerve and canal (for deep inguinal lymph nodes) BUT NOT the femoral nerve
66
what are the layers (from deepest to most superficial) of the inferiolateral anterior abdominal wall (where hernias occur)
parietal peritoneum, extraperitoneal tissue, transversalis fascia, transversus abdominis muscle, internal oblique muscle, aponeurosis of external oblique muscle
67
name the layers surrounding the spermatic cord (from deepest to most superficial)
internal spermatic fascia, cremasteric muscle and fascia, external spermatic fascia
68
name and describe the two kinds of diaphragmatic hernias
sliding hiatal hernia: the stomach herniates upward through the diaphragmatic hiatus; upward shift of GE junction --> hourglass stomach paraesophageal hernia: fundus folds and protrudes into thorax next to esophagus; GE junction is normal
69
``` which ring(s) does an indirect hernia travel through on its way to the scrotum? on which side of the inferior epigastric artery? ```
both deep and superficial inguinal rings travels lateral to the inferior epigastric (to access the deep ring)
70
``` which ring(s) does a direct hernia travel through on its way to the scrotum? on which side of the inferior epigastric artery? ```
direct only travels through superficial inguinal ring travels medial to the inferior epigastric
71
which kind of inguinal hernia is covered by all three layers of the spermatic fascia
indirect inguinal hernia remains covered by all 3 layers of spermatic fascia (by taking path of descent of developing testes)
72
in whom are you more likely to see an indirect inguinal hernia? why? what complication can form?
in infants due to failure of processus vaginalis to close completely hydrocele can form
73
in whom are you more likely to see a direct hernia
in older men
74
what anatomic triangle do direct hernias protrude through? | what structures form this triangle?
Hesselbach's triangle formed by lateral edge of rectus abdominis, inguinal ligament and inferior epigastric vessels
75
what layer of spermatic fascia covers a direct inguinal hernia
external spermatic fascia only
76
what is the anatomic location of a femoral hernia
herniates below the inguinal ligament and lateral to the pubic tubercle
77
are men or women more prone to femoral hernias
women
78
which type of hernia is the leading cause of bowel incarceration
femoral hernia

Gastrointestinal- First Aid (3 decks)

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