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GIGU > GI Organs (Pt. 2) > Flashcards

GI Organs (Pt. 2) Flashcards

1
Q

What is the beginning point and the end point of the ascending colon?

A

beginning point = cecum

end point = right colic flexure

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2
Q

What is lateral to the ascending colon?

A

right paracolic gutter

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3
Q

Is the ascending colon retroperitoneal or intraperitoneal?

A

-retroperitoneal

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4
Q

What is the blood supply to the ascending colon?

A
  • ileocolic A.
  • right colic A.

-both from SMA

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5
Q

What is the venous drainage for the ascending colon?

A
  • ileocolic V.

- right colic V.

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6
Q

What lymph nodes drain the ascending colon?

A

-epicolic and paracolic LN’s

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7
Q

What is the nerve supply for the ascending colon?

A

superior mesenteric nerve plexus

  • T1-T10
  • vagus N.
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8
Q

What part of the colon is the longest and most flexible?

A

transverse colon

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9
Q

What are the starting and ending points of the transverse colon?

A

starting point: right colic flexure

ending point: left colic flexure

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10
Q

Which colic flexure is more superior and why?

A

left colic flexure d/t attachment to the diaphragm by the phrenicocolic ligament

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11
Q

Is the transverse colon retroperitoneal or intraperitoneal?

A

intraperitoneal

-attached by the transverse mesocolon

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12
Q

What is the blood supply to the transverse colon?

A

middle colic A.

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13
Q

What is the venous drainage from the transverse colon?

A

superior mesenteric V.

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14
Q

What is the lymph drainage for the transverse colon?

A

middle colic LN’s

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15
Q

What is the nerve supply for the transverse colon?

A

superior mesenteric plexus

  • T10-L2
  • vagus N.
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16
Q

What is the beginning point and end point of the descending colon?

A 
beginning = left colic flexure
end = sigmoid colon
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17
Q

What is lateral to the descending colon?

A

left paracolic gutter

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18
Q

Is the descending colon retroperitoneal or intraperitoneal?

A

retroperitoneal

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19
Q

What is the blood supply to the descending colon?

A

left colic A.
sigmoid A.

-both from inferior mesenteric A.

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20
Q

What is the venous drainage from the descending colon?

A

inferior mesenteric V.

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21
Q

What is the lymph drainage from the descending colon?

A

epicolic and paracolic LN’s

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22
Q

What is the nerve supply to the descending colon?

A

sympathetic: T12-L2
parasympathetic: pelvic splanchnic nn. via inferior hypogastric nerve plexus

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23
Q

What is the beginning and the end of the sigmoid colon?

A

beginning: descending colon
end: rectum

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24
Q

Is the sigmoid colon retroperitoneal or intraperitoneal?

A

intraperitoneal

  • attached by sigmoid mesocolon
  • -allows freedom of mvmt in the middle
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25
Q

What is a characteristic about the omental appendices of the sigmoid colon?

A

long omental appendices

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26
Q

What is the blood supply to the sigmoid colon?

A
  • left colic A.
  • sigmoid A.
  • from the inferior mesenteric A.
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27
Q

What is the venous drainage of the sigmoid colon?

A

inferior mesenteric V.

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28
Q

What is the lymph drainage from the sigmoid colon?

A

epicolic and paracolic LN’s

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29
Q

What is the nerve supply to the sigmoid colon?

A

sympathetic: T12-L2
parasympathetic: pelvic splanchnic nn. via inferior hypogastric nerve plexus

30
Q

What are the longitudinal bands along the colon and of what do they consist?

A

teniae libera, epiploic teniae, and mesocolic teniae

  • omental appendices attach to epiploic teniae
  • mesoclons attach to the mesocolic teniae

-longitudinal bands of smooth muscle

31
Q

What is the role of the colon?

A

water reabsorption

32
Q

What is formed by the ctx of the teniae coli?

A

haustra = sacculations of the wall of the colon

33
Q

What is the anatomical position of the appendix?

A
  • attached to the posteromedial part of the cecum
  • supported by mesoappendix
  • inferior to ileocecal junction
34
Q

What are symptoms of appendicitis?

A
  • low-grade fever and ill-looking appearance
  • increased pain w/ cough (Dunphy)
  • tenderness at McBurney’s Point
  • involuntary guarding
  • pain in RLQ when LLQ is palpated (Rovsing)
35
Q

What are characteristics of anatomical lobes of the liver?

A
  • not true lobes per biological definition
  • only exist as R and L d/t liver’s internal architecture
  • R lobe is larger and contains accessory lobes
  • -(caudate and quadrate lobes)
  • R and L separated by falciform L. and L sagittal fissure
36
Q

What are characteristics of functional lobes of the liver?

A
  • functionally independent of one another
  • each lobe has its own branch of hepatic A. and V.
  • each lobe is drained by its own hepatic duct
  • R lobe is somewhat larger, though size is equalish
37
Q

What is unique about the caudate lobe that makes it like a “third liver”?

A

-receives vascularization from both branches of the bifurcation of the portal triad

38
Q

Clinical Box: Esophageal Varices

A
  • caused by portal HTN
  • -blood can’t pass thru liver, so reverses into esophagus
  • severe, life-threatening hemorrhage
  • common in pts w/ alcoholic cirrhosis of the liver
39
Q

Clinical Box: Pyrosis

A
  • most common type of esophageal discomfort
  • burning sensation in abdominal part of esophagus
  • result of regurgitation of food and/or fluid
  • may be associated w/ hiatal hernia
  • perceived as a chest sensation vs. abdominal
40
Q

Clinical Box: Bariatric Sx

A
  • performed on morbidly obese
  • most frequent performed stomach sx (laparoscopic)

-aim to reduce stomach volume, reduce nutrient absorptive area, or a combo

41
Q

What are examples of restrictive bariatric surgeries?

A
  • banding
  • resectioning to create a pouch or sleeve
  • folding stomach onto itself
42
Q

What are examples of malabsorptive bariatric surgeries?

A

-rerouting the connection of the stomach with the small intestines

43
Q

What is an example of a mixed procedure bariatric surgery?

A

-gastric bypass

44
Q

What are the results of bariatric surgery?

A
  • significant weight loss
  • reduced diabetes
  • reduced malabsorptive syndrome
  • reduced sleep apnea
45
Q

True or False: bariatric surgeries have a relatively high risk of post-surgical complications

A

True; strict adherence to a post-surgical diet of healthy eating is required for success

46
Q

Clinical Box: Displacement of Stomach

A
  • pancreatic pseudocysts and abscesses in omental bursa may push stomach anterior
  • visible in diagnostic imaging
47
Q

What is a complication of pancreatitis that involves the stomach?

A

-following pancreatitis, the posterior wall of the stomach may adhere to part of the posterior wall of the omental bursa that covers the pancreas

48
Q

Clinical Box: Pylorospasm

A
  • sometimes occurs in infants 2-12wks
  • failure of smooth muscle fibers around pylorus to relax
  • food doesn’t pass to duodenum easily
  • stomach becomes overly full
  • discomfort and vomiting
49
Q

Clinical Box: Congenital Hypertrophic Pyloric Stenosis

A
  • thickening of smooth muscle in pylorus
  • more common in males; possible genetic factors
  • elongated, overgrown pylorus, narrow canal
  • dilated stomach proximal to pylorus
  • Tx: pylorotomy, cut through hypertrophied circular M.
50
Q

Clinical Box: Carcinoma of the Stomach

A
  • malignant tumor in body or pylorus, may be palpable
  • gastroscope inspects mucosa of inflated stomach
  • stomach has extensive lymph drainage
  • -impossible to remove all LN’s (ex: aortic and celiac)
  • most gastric CA detected too late for Sx control
51
Q

Clinical Box: Gastrectomy and LN Resection

A
  • total gastrectomy is uncommon
  • arteries may be ligated during a partial gastrectomy
  • -circulation unaffected d/t many anastomoses
  • all gastric LN’s drain to celiac LN’s
52
Q

Clinical Box: Visceral Referred Pain

A
  • organic pain varies from dull to severe
  • -poorly localized and radiates to dermatome level

-visceral referred pain in skin region supplied by same sensory ganglia and spinal cord segment

53
Q

Clinical Box: Duodenal Ulcers

A
  • most occur on posterior wall of superior part

- occasionally an anterior ulcer perforates the wall and contents enter the peritoneum, causing peritonitis

54
Q

What are some complications of duodenal ulcers?

A

-liver, GB and pancreas in close proximity to superior part may adhere or become ulcerated themselves

  • intraluminal bleeding
  • erosion of gastroduodenal A. and severe hemorrhage
55
Q

Clinical Box: Development Changes in Mesoduodenum

A
  • in early fetal period, entire duodenum has mesentery

- -most fuses to posterior wall b/c of pressure from overlying transverse colon

56
Q

What is the surgical significance of the duodenum being secondarily retroperitoneal?

A

-duodenum (and pancreas) can be separated from underlying retroperitoneal viscera during surgery involving the duodenum w/o damaging blood supply to the kidneys and ureters

57
Q

What are the duodenal fossae?

A
  • 2-3 inconsistent folds around the duodenojejunal flexure: superior, para, and inferior duodenal fossae
  • paraduodenal fossa is large, to the left of ascending duodenum
58
Q

Why is the paraduodenal fossa of clinical significance?

A
  • it is large
  • if a loop of intestine enters, it can become strangulated

-during Sx, be careful not to injure branches of IMA/IMV or branches of the left colic A.

59
Q

Clinical Box: Embryological Rotation of Midgut

A
  • for a 4wk period, midgut (supplied by SMA) is herniated into proximal part of umbilical cord
  • as it is allowed to recede d/t decrease in relative size of kidneys and liver, it rotates 270 around SMA axis
60
Q

Clinical Box: Navigating the Small Intestines

A

-place hand, finger, and thumb on each side of intestine and grasp mesentery

  • follow mesentery to its root, untwisting as needed
  • cranial = orad and caudal = aborad
61
Q

Clinical Box: Ischemia of the Intestines

A
  • occlusion of vasa recta

- if severe, necrosis results and leads to paralytic obstruction of the intestine (aka: ileus)

62
Q

What are the symptoms of ischemia of the intestines?

A
  • severe colicky pain
  • abdominal distention
  • vomiting
  • fever
  • dehydration
63
Q

What is the mechanism for the occlusion of the vasa recta that causes intestinal ischemia?

A
  • emboli from the heart sent inferiorly via descending aorta tend to lodge in the SMA and its branches
  • b/c SMA arises at a less acute angle from the aorta than other branches such as the celiac trunk
64
Q

Clinical Box: Appendectomy

A
  • standard procedure is laparscopic
  • peritoneal cavity inflated with carbon dioxide

-if surgeons have trouble finding appendix, they look for convergence of the teniae coli on surface of cecum

65
Q

Clinical Box: Mobile Ascending Colon

A
  • in 11 percent of people, the cecum and proximal colon are mobile d/t a mesentery
  • may cause cecal bascule (folding) or volvulus and intestinal obstruction
66
Q

What is the treatment for Mobile Ascending Colon?

A

-cecopexy = fixation … teniae coli of the cecum is sutured to the abdominal wall

67
Q

Clinical Box: Colonoscopy, Sigmoidoscopy and Colorectal Cancer

A

-small instruments can be passed through scopes to facilitate minor procedures (biopsies, etc.)

  • most tumors occur in sigmoid (men and younger pts)
  • ascending colon tumors more common in women
68
Q

Clinical Box: Diverticulosis

A
  • multiple false diverticula develop on intestine
  • primarily affects mid-age and elderly; sigmoid colon
  • occur commonly where nutrient aa. perforate bowel
  • diverticula subject to infection and rupture
  • -diverticulitis can distort or erode nutrient aa.
69
Q

What type of diet is beneficial in reducing occurrence of diverticulosis?

A

high fiber diet

70
Q

Clinical Box: Volvulus of the Sigmoid Colon

A

-twisting of the sigmoid colon d/t long middle portion of the sigmoid mesocolon

  • results in obstruction and ischemia
  • acute emergency; necrosis if untreated

GIGU (9 decks)

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