GI Cases DSA/CIS

Question 1

stomach CP?

Answer 1

In the left 5th intercostal space between the mid-clavicular line and sternum

Midway between the spinous process and tip of the transverse process on the Left 5th and 6th thoracic vertebrae

Question 2

Liver CP?

Answer 2

In the right 5th and 6th intercostal space between the mid-clavicular line and sternum

Midway between the spinous process and tip of the transverse process on the Right 5th, 6th and 7th thoracic vertebrae

Question 3

gall bladder CP?

Answer 3

In the right 6th intercostal space between the mid-clavicular line and sternum

Midway between the spinous process and tip of the transverse process on the Right 6th and 7th thoracic vertebrae

Question 4

pancreas CP?

Answer 4

Right 7th intercostal space close to the costochondral junction

Midway between the spinous process and tip of the transverse process on the Right 7th and 8th thoracic vertebrae

Question 5

intestinal peristalsis CP? (constpiation)

Answer 5

Bilaterally in the muscle tissues between the ASIS and the Greater Trochanter

Costovertebral junction of the 11th rib on the Right

Question 6

pyloris CP?

Answer 6

Anterior Midline of the Sternum (angle of Louis to xiphoid)

Right costovertebral junction of the 10th rib

Question 7

appendix CP?

Answer 7

Tip of the right 12th rib, upper edge

Inter-transverse space between 11th and 12th thoracic vertebrae on the Right

Question 8

Stomach hyperacidity CP

Answer 8

5th and 6th intercostal space from the mid-clavicular line to the sternum on the left

intertransverse space, midway between the spinous and transverse processes, between 5th and 6th vertebrae on the left

Question 9

LIver/GB CP

Answer 9

th and 7th intercostal space from mid-clavicular line to the sternum on the right

intertransverse space, midway between the spinous and transverse processes, between 6th and 7th vertebrae on the right

Question 10

appendix cp

Answer 10

upper edge near the tip of the 12th rib on the R

11th intertransverse space on the right

Question 11

colon cp - spastic constipation/colitis

Answer 11

An area 1-2” anterolateral aspect of the thighs along the femur starting at the greater trochanter and extending to within an inch of the knees

right femur:
Upper fifth corresponds with the cecum
Middle 3/5’s corresponds with ascending colon
Last 1/5 represents hepatic flexure and first 2/5’s of transverse colon

left femur:
Upper fifth corresponds with the sigmoid
Middle 3/5’s corresponds with descending colon
Last 1/5 represents splenic flexure and last 3/5’s of transverse colon

– TP of L2 – TP of L4 a triangular area reaching across to the iliac crest

Question 12

vagus n. exits where?

Answer 12

cranium via the jugular foramen

Question 13

sympathetic control of GI tract?

Answer 13

Tends to inhibit GI function
Frequently activated in pathological situations
Inhibits smooth muscle
Induces contraction of sphincters
Regulates blood flow in the GI tract

Question 14

PS control of GI tract?

Answer 14

Activates physiological processes in the gut wall
Allows filling of the stomach to occur without an increase in intraluminal pressure
Generally involved in relaxation of sphincters
Contraction of smooth muscle layers in the colon
Controls the caliber of the internal anal sphincter

Question 15

sympathetically driven GI sx?

Answer 15

Constipation
Bloating
Pain
Contraction of sphincters
Increased vasomotor tone (may lead to decreased mucus production in stomach and intestines)

** increased vascular tone, decrased O2 and nutrients to tissues, decreased peristalsis

Question 16

PS drive sx?

Answer 16

Nausea
Vomiting
Diarrhea
Hypermotility
Relaxation of sphincters
Increased mucus secretion
Increased acid production in the stomach

= increased in gastritis, ulcers, GERD

Question 17

Post-Operative Ileus

Answer 17

Failure to pass flatus or stool for 3/6 days after surgery
Transient impairment of function and motility

Due to:
Mechanical irritation
Edema of tissues – mesentery and intestine
Inflammatory molecules which cause the
Activation of inhibitory neural reflexes
Medications, particularly opiates (which don’t inhibit motility, but increased uncoord. contractions w/ increased tone and decreased transit)

Question 18

pathophy. of lymphatics?

Answer 18

Impaired flow increases tissue congestion

Impaired nutrient absorption from the intestines

Congestion increases the likelihood of fibrosis, and susceptibility to infection

Question 19

arndt-Schultz law

Answer 19

Weak stimuli accelerate physiologic activity

Medium stimuli inhibit physiologic activity

Strong stimuli halt physiologic activity

Question 20

how does visceral manipulation work?

Answer 20

sends stimuli to mechanical sensors –> enteric nervous system

helps with things that block it like adhesions, scars, inflammation

Question 21

Visceral joints?

Answer 21

Double layer system - serous fluid creates suction between surfaces of the peritoneum, etc.

Ligamentous system – folds of peritoneum or pleura binding an organ to the wall of the cavity or to another organ
- Not present for structural stability like skeletal ligaments

Turgor and Intracavitary pressure – hold the viscera in place, remain constant in mass, yet stick together

Mesenteric system- folds of peritoneum that support the nerves, arteries, veins and lymphatics of the small and large intestines

Omental system – folds of peritoneum that join 2 elements of the digestive tract together and has a neurovascular role

Question 22

chapmans small intestines

Answer 22

Anterior: Bilateral 8-9th, 9-10th, and 10-11th intercostal spaces close to the costochondral junctions

Posterior: Bilateral 8-9th, 9-10th, and 10-11th intertransverse spaces midway between the spinous process and the tip of the transverse process

Question 23

chapmans for atonic constipation?

Answer 23

Anterior: Bilaterally in the muscle tissues between the ASIS and the Greater Trochanter

Posterior: Bilaterally along the 11th rib at the costovertebral junction.

Question 24

colic

Answer 24

Crying and fussing more than
3 hours per day
3 days a week
For more than 3 weeks

Inconsolable, excessive crying associated with hypertonicity, perceived pain, borborygmus, wakefulness

Cyclic

Onset 2-6 weeks old and lasts typically 3 months

Pathophysiology? 
Dietary - mom's diet
Psychological - maternal depression
Gastrointestinal - H. pylori 
Hormonal
Neurological immaturity

Question 25

what may work to treat colic?

Answer 25

• fennel extract tea
• sucrose/glucose solutions
• manipulation
• probiotics

Question 26

what childhood problems result from colic?

Answer 26

Recurrent abdominal pain (abdominal migraine)

Allergic diseases (asthmatic bronchitis, rhinitis, conjunctivitis, atopic eczema, food allergy)

Psychological disorders (sleep disorders, aggressiveness, fussiness, ‘supremacy’)

Question 27

where are ganglia located?

Answer 27

celiac = just below zyphoid
inferior = just above umbilicus
superior mesenteric = inbetween the two

Question 28

retroperitoneal ab. contents?

Answer 28

adrenal gland, 2/3 duodenum, pancreas, ureter, ascending/descending colon, kidneys, rectum

Question 29

mesenteric root

Answer 29

L L2 to R SI

Question 30

hepatic flexure

Answer 30

diaphragm via R phrenicocolic

Question 31

splenic flexure

Answer 31

greater curvature of stomach - attaches to diaphragm by left phrenicocolic ligmanet - spleen is superior