GI - Grab Bag

Question 0

Omphalocele

Answer 0

Persistence of herniation of abdominal contents into umbilical cord SEALED by peritoneum

Question 1

Gastroschisis

Answer 1

Extrusion of the abdominal contents through abdominal folds NOT COVRED by peritoneum

Question 2

Difference between gastroschisis and omphalocele?

Answer 2

Gastroschisis is extrusion of abdominal contents through abdominal folds not covered by peritoneum

Omphalocele is persistence of herniation of abdominal contents into umbilical cord SEALED by peritoneum

Question 3

Duodenal atresia

Answer 3

Associated with trisomy 21

Question 4

Apple peel atresia

Answer 4

Jejunal, ileal, colonic atresia - due to vascular accident

Affected area of the bowel assumes a spiral appearance, described as an apple peel like appearance!

Question 5

When does the midgut herniate through the umbilical ring? When does it return to rotate around SMA?

Answer 5

Week 6

Week 10

Question 6

H-type of tracheo-esophageal fistula

Answer 6

Fistula alone - shaped like an H! Think about it!

Question 7

What will CXR show in pure atresia / isolated?

Answer 7

Gasless abdomen

Question 8

Palpable olive mass in epigastric region and nonbilious projectile vomiting at 2-6 weeks old.

Answer 8

Congenital pyloric stenosis.

Hypertrophy of pylorus causing obstruction

Question 9

Treatment for congenital pyloric stenosis?

Answer 9

Surgical incision.

Question 10

When the ventral and dorsal parts of the pancreas fail to fuse at 8 weeks this is called…

Answer 10

Pancreas divisum

Think Pd –> join the letters together you get 8 –> 8 wks

Question 11

When the ventral pancreatic bud abnormally encircles the second part of duodenum, forming a ring of pancreatic tissue that causes duodenal narrowing

Answer 11

Annular pancreas

Question 12

When you compress the hepatoduodenal ligament between thumb and forefinger to control bleeding this is called?

What does the hepatoduodenal ligament even do?

Answer 12

Pringle maneuver

(it’s like you are squeezing a pringle!)

It contains the portal triad (proper hepatic artery, portal vein, common bile duct)

Question 13

Layers of the gut wall from lumen (inside) to outside

Answer 13

Mucosa (epithelium, lamina propria - support, muscularis mucosa - motility)
Submucosa (includes submucosal nerve plexus - Meissner)
Muscularis externa - inner circular muscle layer, auerbach’s plexus, outer circular muscle layer
Serosa (when intraperitoneal) or adventitia (when retroperitoneal)

Remember: epic lame mice subsist inside my outlandish ceramic.

Question 14

How far do ulcers extend versus erosions?

Answer 14

Ulcers - into the submucosa inner or outer muscular layer

Erosions - into the mucosa only

Question 15

Frequency of electric rhythms (slow waves)

Answer 15

Stomach - 3 waves per minute
Duodenum - 12 waves per minute
Ileum - 8-9 waves per minute

3 * 4
Then that times 3/4

Question 16

What kind of histology is the esophagus?

Answer 16

Non-keratinized stratified squamous

Question 17

Duodenum (histology?)

Answer 17

Brunner glands (submucosa) 
Crypts of lieberkuhn
Remember: the Subway (submucosa) B-runner (he's not very good, that's why he's not an A-runner) decided to DO (duodenum) the Crypts of Lieberkuhn.

Question 18

Ileum histology

Answer 18

Peyer patches (lamina propria, submucosa)
Plicae circulares (proximal ileum)
Crypts of lieberkuhn
Largest number of goblet cells in the small intestine

When I’m Ill, I pay (Peyer’s) for a lamb subway (lamina propria, submucosa) and goblets (goblet cells) of medicine.

Question 19

Transverse portion (third segment of the duodenum) is trapped between SMA and aorta, causing intestinal obstruction

Answer 19

SMA syndrome.

Question 20

Arteries supplying non-GI structures branch _____. arteries supplying GI structures branch ____.
(off the aorta).

Answer 20

Laterally.

Medially.

Question 21

A better mnemonic than i ate ten eggs at twelve

Answer 21

My friends and I ate t eggs with venison at 12
Phrenic and IVC at 8 
Esophagus and vagus at 10
Azygous 
Aorta
Thymus? Whatever the t stands for - 12

Question 22

Esophageal anastomosis associated with portal htn

Answer 22

Left gastric and esophageal

Question 23

Umbilical anastomosis associated with portal hypertension

Answer 23

Para-umbilical with small epigastric veins of the anterior abdominal wall

Question 24

Rectal anastomoses in portal hypertension

Answer 24

Superior rectal with middle and inferior rectal

Leads to anorectal varices

Question 25

What kind of cancer do you get above the pectinate line?

Answer 25

Adenocarcinoma

Question 26

What kind of cancer do you get below the pectinate line?

Answer 26

Squamous cell carcinoma

Question 27

Zone I of the liver

Answer 27

Periportal zone

First affected by viral hepatitis and ingested toxins such as cocaine. (probably bc there is more blood supply)

Question 28

Apical surface of hepatocytes face what?

Basolateral surfaces face what.

Answer 28

Apical surface face bile canaliculi -
basolateral face sinusoids.

Think BA. BS. 2 kinda of degrees.

Question 29

Zone III

Answer 29

Pericentral vein / centrilobular zone

First affected by ischemia.
Contains cyt p450 system
Most sensitive to metabolic toxins
Site of alcoholic hepatitis

Question 30

Zone II

Answer 30

Intermediate Zone

Question 31

Vitamin and mineral absorption

Answer 31

Iron fist bro!
Iron - fe2+ in duodenum
Folate - absorbed in jejunum and ileum
B12 - absorbed in terminal ileum along with bile acids, requires intrinsic factor (which, if I’m not much mistaken, was made much farther up.

Question 33

Barrett esophagus

Answer 33

Glandular metaplasia.
Replacement of nonkeratinized stratified squamous epithelium (native esophagus) with intestinal epithelium (nonciliated columnar with goblet cells) in the distal esophagus.
Due to chronic acid reflux (GERD).
Associated with esophagitis, esophageal ulcers’ and increased risk of ESOPHAGEAL ADENOCARCINOMA.

Question 34

What kind of kidney stones is Crohn’s disease associated with?

Answer 34

Calcium oxalate stones

Increased concentration of oxalate in the urine is associated with intestinal malabsorption syndromes like Crohn’s. Calcium oxalate stones may result.

Oxalate stones are due to excessive GI absorption of oxalate.
Hyperoxaluria occurs in people with small bowel resection, IBD, and other malabsorptive states. The increased intestinal fat binds dietary calcium, which is then unavailable to bind oxalate as usual. Therefore increased oxalate absorption in large bowel occurs and precipitates in the kidney.

Increased oxalate can also occur in people who drink large amounts of tea, coffee, beer, chocolate, and ethylene glycol overdose.

Question 35

What kind of stones is ethylene glycol associated with?

Answer 35

Calcium oxalate stones