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Gastrointestinal- First Aid > GI anatomy (335-344) > Flashcards

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
Q

what frequency is the basal electric rhythm in the stomach?
duodenum?
ileum?

A

3 waves/ min
12 waves/ min
8-9 waves/ min

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26
Q

what histologically characterizes the esophagus

A

nonkeratinized stratified squamous epithelium

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27
Q

what kind of cell characterizes the stomach

A

gastric glandular cells

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28
Q

describe the intestinal wall morphology that characterizes the duodenum

A

Brunner glands and crypts of Lieberkuhn;

villi and microvilli

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29
Q

describe the wall morphology of the jejunum

A 
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)

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30
Q

describe the wall of the ileum

A 
Peyer patches (in the lamina propria and submucosa), plicae circulares (in the proximal ileum), crypts of Lieberkuhn,
villi and microvilli
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31
Q

where is the largest number of goblet cells in the small intestines found

A

the ileum

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32
Q

describe the colon wall in terms of crypts, villi and goblet cells

A

crypts of Lieberkuhn
NO villi
numerous goblet cells

33
Q

what is SMA syndrome

A

when the transverse (3rd) portion of the duodenum gets trapped between the SMA and the aorta the intestinal tract becomes obstructed

34
Q

at what vertebral level does the aorta bifurcate into the common iliacs

A

L4 (“bifourcation”)

35
Q

list the arteries branching laterally off of the abdominal aorta from most superior to most inferior

A
  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
Q

list the vertebral levels for the celiac trunk, SMA, renal arteries, and IMA

A

celiac trunk: T12,
SMA and renal arteries: L1
IMA: L3

37
Q

what is the blood supply and parasympathetic innervation of the foregut

A

celiac artery and vagus

38
Q

what structures comprise the foregut

A

pharynx to duodenum, pancreas, liver, gall bladder, spleen

39
Q

what is the blood supply and parasympathetic innervation to the midgut

A

SMA and vagus

40
Q

what is the blood supply and parasympathetic innervation to the hindgut

A

IMA and pelvic

41
Q

what are the three branches of the celiac trunk

A

common hepatic, splenic and left gastric arteries

42
Q

which arteries supplied by the celiac artery have strong anastomoses between them?
which have poor anastomoses?

A

between left and right gastroepiploics and between left and right gastrics are strong

short gastrics have poor anastomoses if splenic artery is blocked

43
Q

what arterial anastomoses exist that can compensate for blockage of branches off the abdominal aorta

A
  • 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
Q

what are 3 portosystemic anastamoses that can occur as a result of portal hypertension

A
  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
Q

what anastamosis is created surgically as a treatment for portal hypertension

A

transjugular intrahepatic portosystemic shunt (TIPS) is created between portal vein and hepatic vein to shunt blood from portal system to systemic circulation

46
Q

what two embryologic layers meet at the pectinate line

A

the endoderm (hind gut) and ectoderm

47
Q

what kind of hemorrhoids are seen above vs. below the pectinate line

A

internal hemorrhoids above the pectinate line

external hemorrhoids below the pectinate line

48
Q

how does blood get from the aorta to the rectum above the pectinate line?
how does this blood drain back to portal system?

A

aorta–> IMA –> superior rectal artery

superior rectal vein–> IMV–> portal system

49
Q

how does blood get from the aorta to the rectum below the pectinate line?
how does this blood drain back to portal system?

A

aorta–> internal iliac arteries–> internal pudendal arteries –> inferior rectal arteries

inferior rectal veins–> internal pudendal veins –> internal iliac veins –> IVC

50
Q

are internal hemorrhoids painful?

why or why not?

A

no; b/c they receive visceral innervation

51
Q

where do the lymphatics of the rectum above the pectinate line drain to?

A

deep lymph nodes

52
Q

are external hemorrhoids painful?

why or why not?

A

yes; they receive somatic innervation from inferior rectal branch of pudendal nerve

53
Q

where do the lymphatics of the rectum below the pectinate line drain to?

A

superficial inguinal nodes

54
Q

what is anal fissure and what symptoms does it cause

A

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
Q

what surface of the hepatocytes face the sinusoids

A

basolateral

56
Q

what surface of the hepatocytes face the bile canaliculi

A

apical (secrete bile out apical side)

57
Q

describe the three zones of hepatic tissue

A

Zone 1: periportal zone
Zone 2: intermediate zone (bile and blood flow in opposite directions)
3. Zone 3: pericentral (centrilobular) zone

58
Q

which zone of hepatic tissue is first to be affected by viral hepatitis or acted on by toxins like cocaine

A

zone 1 (periportal zone)

59
Q

which zone of hepatic tissue is first to be affected by ischemia

A

zone 3 (centrilobular)

60
Q

which zone of hepatic tissue is the site of alcoholic hepatitis and contains CYP450

A

zone 3 (centrilobular)

61
Q

where must a gallstone be in order to block both the bile duct and pancreatic duct

A

ampulla of Vater

62
Q

tumor in what location commonly causes obstruction of the common bile duct

A

tumor in the head of the pancreas

63
Q

name the vessels/nerves running through the femoral region (underneath the inguinal ligament) from lateral to medial

A

NAVEL: femoral Nerve, femoral Artery, femoral Vein, (empty), Lymphatics

64
Q

what comprises the femoral triangle

A

femoral nerve, artery and vein

65
Q

what is found within the femoral sheath

A

femoral artery, nerve and canal (for deep inguinal lymph nodes)
BUT NOT the femoral nerve

66
Q

what are the layers (from deepest to most superficial) of the inferiolateral anterior abdominal wall (where hernias occur)

A

parietal peritoneum, extraperitoneal tissue, transversalis fascia, transversus abdominis muscle, internal oblique muscle, aponeurosis of external oblique muscle

67
Q

name the layers surrounding the spermatic cord (from deepest to most superficial)

A

internal spermatic fascia, cremasteric muscle and fascia, external spermatic fascia

68
Q

name and describe the two kinds of diaphragmatic hernias

A

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
Q 
which ring(s) does an indirect hernia travel through on its way to the scrotum?
on which side of the inferior epigastric artery?
A

both deep and superficial inguinal rings

travels lateral to the inferior epigastric (to access the deep ring)

70
Q 
which ring(s) does a direct hernia travel through on its way to the scrotum?
on which side of the inferior epigastric artery?
A

direct only travels through superficial inguinal ring

travels medial to the inferior epigastric

71
Q

which kind of inguinal hernia is covered by all three layers of the spermatic fascia

A

indirect inguinal hernia remains covered by all 3 layers of spermatic fascia (by taking path of descent of developing testes)

72
Q

in whom are you more likely to see an indirect inguinal hernia? why?
what complication can form?

A

in infants due to failure of processus vaginalis to close completely

hydrocele can form

73
Q

in whom are you more likely to see a direct hernia

A

in older men

74
Q

what anatomic triangle do direct hernias protrude through?

what structures form this triangle?

A

Hesselbach’s triangle

formed by lateral edge of rectus abdominis, inguinal ligament and inferior epigastric vessels

75
Q

what layer of spermatic fascia covers a direct inguinal hernia

A

external spermatic fascia only

76
Q

what is the anatomic location of a femoral hernia

A

herniates below the inguinal ligament and lateral to the pubic tubercle

77
Q

are men or women more prone to femoral hernias

A

women

78
Q

which type of hernia is the leading cause of bowel incarceration

A

femoral hernia

Gastrointestinal- First Aid (3 decks)

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