GI, Topnotch Flashcards
Vertebral level: Umbilicus
IVD of L3-L4
Vertebral level: Subcostal plane
10th rib, L3
Iliac tubercle
L5
Central regions of the anterior abdomen (3)
1) Epigastric 2) Periumbilical 3) Hypogastric/pelvic
Lateral regions of the anterior abdomen
1) Hypochondriac 2) Lumbar 3) Inguinal
Dermatomal level: Apex of supraclavicular fossa
C3
Dermatomal level: Acromioclavicular joint
C4
Dermatomal level: Radial side of antecubital fossa
C5
Dermatomal level: Dorsal surface of proximal phalanx of thumb
C6
Dermatomal level: Dorsal surface of proximal phalanx of middle finger
C7
Dermatomal level: Dorsal surface of proximal phalanx of little finger
C8
Dermatomal level: Ulnar side of antecubital fossa
T1
Dermatomal level: Apex of axilla
T2
Dermatomal level: Nipple/4th ICS MCL
T4
Dermatomal level: Midway between nipple and xiphisternum MCL
T5
Dermatomal level: Xiphisternum
T6
Dermatomal level: 1/4 between xiphisternum and umbilicus MCL
T7
Dermatomal level: 1/2 between xiphisternum and umbilicus, MCL
T8
Dermatomal level: Umbilicus MCL
T10
Dermatomal level: Midpoint of inguinal ligament
T12
Dermatomal level: Anteromedial thigh
L2
Dermatomal level: Medial femoral condyle
L3
Dermatomal level: Medial malleolus
L4
Dermatomal level: Dorsum of foot
L5
Dermatomal level: Lateral heel
S1
Dermatomal level: Popliteal fossa
S2
Dermatomal level: Ischial tuberosity
S3
Dermatomal level: Perianal area 1 cm lateral to mucocutaneous junction
S4-5
Most superficial abdominal muscle
External oblique
External oblique: Direction of fibers
Obliquely downward and medially
Immediately deep to the external oblique
Internal onlique
Internal oblique: Direction of fibers
Obliquely upward and medially
Components of conjoint tendon
Aponeurotic fivers of 1) Internal oblique 2) Transversus abdominis
Muscle whose aponeurosis splits to form the rectus sheath
Internal oblique
Innermost abdominal muscle
Transversus abdominis
Muscle on either side of line alba
Rectus abdominis
Lateral borders of rectus abdominis
Linea semilunaris
Crescentic border on the posterior wall of the abdomen midway between the umbilicus and pubic crest
Arcuate line
Characteristic arrangement of fibers above arcuate line
Internal oblique aponeurosis splits to form rectus sheath (present posterior layer)
Characteristic arrangement of fibers below arcuate line
Internal oblique aponeurosis is superficial to the rectus sheath (absent posterior layer) and transversalis fascia is directly below the rectus abdominis muscle
Contents of rectus sheath (4)
1) Rectus abdominis 2) Pyramidalis 3) Superior and inferior epigastric vessels 4) Lower 5 intercostal and subcostal vessels and nerves
Boundaries of foramen of Winslow: Anterior
Hepatoduodenal ligament
Boundaries of foramen of Winslow: Posterior
IVC
Boundaries of foramen of Winslow: Superior
Caudate lobe of liver
Boundaries of foramen of Winslow: Inferior
Superior part of duodenum
Extensions of visceral peritoneum (3)
1) Mesentery 2) Ligaments 3) Omentum
Layers: Mesentery
2
Layers: Ligaments
2
Supports hollow viscous to body wall for neurovascular communication
Mesentery
Connects viscera to each other or to the body wall
Ligaments
Connects the stomach with other viscera
Omentum
Layers: Greater omentum
4
Abdominal policeman
Greater omentum
3 parts of greater omentum
1) Gastrophrenic 2) Gastrosplenic 3) Gastrocolic
Layers: Lesser omentum
2
Greater omentum connects
Greater curvature and proximal duodenum to transverse colon
Lesser omentum connects
Lesser curvature to fissure for ligamentum venosum and porta hepatic of liver
Hepatoduodenal ligament: Posterior
Portal vein
Hepatoduodenal ligament: Anterior to the right
CBD
Hepatoduodenal ligament: Anterior to the left
Hepatic artery
Inflammation of this layer of peritoneum causes rebound tenderness and guarding
Parietal peritoneum
Brough about by congestion of the venous drainage of the abdomen
Ascites
Paracentesis at the midline goes through these layers (7)
1) Skin 2) Superficial fascia 3) Deep fascia 4) Linea alba 5) Transversalis fascia 6) Extraperitoneal fat 7) Parietal peritoneum
Paracentesis lateral to the inferior epigastric artery and above the deep circumflex artery goes through these layers (7)
1) Skin 2) External oblique 3) Internal oblique 4) Transversus abdominis 5) Transversalis fascia 6) Extraperitoneal fat 7) Parietal peritoneum
Branches of the splenic artery (2)
1) Left gastroepiploic 2) Short gastric
Branches of the common hepatic artery (3)
1) Right gastric 2) Right and left hepatic 3) Gastroduodenal
Branches of the gastroduodenal artery (2)
1) Right gastroepiploic 2) Superior pancreaticoduodenal
Branches of the SMA (5)
1) Inferior pancreaticoduodenal 2) Middle colic 3) Right colic 4) Ileocolic 5) Jejunal-ileal
Branches of the IMA (3)
1) Left colic 2) Sigmoid 3) Superior rectal
Common site of aortic aneurysm
Just proximal to the bifurcation at L4
Occlusion of the celiac artery results in collateral circulation by way of anastomosis between
Pancreaticoduodenal and gastroduodenal arteries
Branch of celiac artery eroded: Penetrating ulcer of posterior wall of stomach
Splenic
Branch of celiac artery eroded: Lesser curvature of stomach
Left gastric
Posterior wall of 1st part of duodenum
Gastroduodenal
Erosion of celiac circulation may present as referred pain at
Shoulder
Tributaries of IVC (8)
1) Right and left hepatic 2) Right suprarenal 3) Right gonadal 4) Right and left renal 5) Inferior phrenic 6) Lumbar 7) Right and left common iliac 8) Median sacral
May be compressed by aneurysm of SMA causing renal and adrenal htn
Left renal vein
Tributaries of portal venous circulation
1) Superior mesenteric 2) Inferior mesenteric 3) Splenic 4) Left gastric 5) Paraumbilical
Length of esophagus
25 cm
Esophagus: Enters the stomach at
Cardia
Continuous above with laryngeal part of pharynx at the level of
C6
Passes through diaphragm at the level of
T10
Structures through diaphragm: T8
IVC and right phrenic via Caval hiatus
Structures through diaphragm: T10
Esophagus and vagus via esophageal hiatus
Structures through diaphragm: T12
Aorta, thoracic duct, and azygos vein via aortic hiatus
Esophageal constrictions
1) Upper/Pharyngoesophageal 2) Middle/Thoracic 3) Inferior/Diaphragmatic
Upper esophageal constriction is caused by
Cricopharyngeus muscle
Middle esophageal constriction is caused by
Aortic arch and left main bronchus
Inferior esophageal constriction is caused by
Esophageal hiatus
T/F Esophageal constrictions are common sites of carcinoma
T
Relations of the esophagus in the neck: Anterior (2)
1) Trachea 2) Recurrent laryngeal nerves
Relations of the esophagus in the neck: Posterior (2)
1) Prevertebral layer of deep cervical fascia 2) Vertebral column
Relations of the esophagus in the neck: Lateral
Thyroid gland
Relations of the esophagus in the thorax: Anterior (4)
1) Trachea 2) Left recurrent laryngeal nerve 3) Left main bronchus 4) Pericardium
Relations of the esophagus in the thorax: Posterior (5)
1) Bodies of thoracic vertebrae 2) Thoracic duct 3) Azygos vein 4) Right posterior intercostal artery 5) Descending thoracic aorta
Relations of the esophagus in the thorax: Right (2)
1) Mediastinal pleura 2) Azygos vein
Relations of the esophagus in the thorax: Left (4)
1) Left subclavian 2) Aortic arch 3) Thoracic duct 4) Mediastinal pleura
Relations of the esophagus in the abdomen: Anterior
Posterior surface of left lobe of liver
Relations of the esophagus in the abdomen: Posterior
Left crus of diaphragm
Arterial supply to the esophagus: Upper 3rd
Inferior thyroid artery from subclavian
Arterial supply to the esophagus: Middle 3rd
Descending thoracic aorta
Arterial supply to the esophagus: Lower 3rd
Left gastric artery from celiac trunk
Venous drainage of the esophagus: Upper 3rd
Inferior thyroid vein
Venous drainage of the esophagus: Middle 3rd
Azygos vein
Venous drainage of the esophagus: Lower 3rd
Left gastric vein
Lymphatic drainage of esophagus: Upper 3rd
Deep cervical
Lymphatic drainage of esophagus: Middle 3rd
Superior and inferior mediastinal
Lymphatic drainage of esophagus: Lower 3rd
Celiac
Management for oesophageal haemorrhage from varicose by balloon insertion
Sengstaken-Blakemore Balloon Insertion
Average distance between external nasal orifices and stomach
44 cm
Capacity of stomach
1.5 L
Part of esophagus near the GEJ
Cardia
Part of esophagus that is dilated superiorly
Fundus
Part of esophagus between the fundus and pylorus (major part)
Body
Distal part of stomach
Pylorus
Sharp indentation of the stomach that approximates the junction of the body and pylorus
Angular incisura/notch
Concave border of stomach
Lesser curvature
Convex border of stomach
Greater curvature
Level of the cardiac orifice of stomach
6th left costal cartilage 2-4 cm from median plane at the level of T10 or T11
Level of the fundus of stomach
5th left rib, MCL
Level of the greater curvature of stomach
Up to 10th costal cartilage
Level of the pyloric antrum of stomach
9th costal cartilage or at L1 approximately 1.25 cm from midline
Level of the pyloric canal of stomach
Right side, L2-L4
Layer that hypertrophies in hypertrophic pyloric stenosis
Muscularis externa
Anterior relations of stomach (3)
1) Diaphragm 2) Left lobe of liver 3) Anterior abdominal wall
Posterior relations of stomach (2)
1) Omental bursa 2) Pancreas
On which the stomach rests when a person is lying supine
Stomach bed
Forms the stomach bed
Structures forming the posterior wall of the omental bursa
Structures forming the posterior wall of the omental bursa (6)
1) Left dome of diaphragm 2) Spleen 3) Left kidney and adrenal gland 4) Splenic artery 5) Pancreas 6) Transverse mesocolon and colon
Blood supply of stomach: Lesser curvature
Right and left gastric arteries
Blood supply of stomach: Greater curvature
Right and left gastroepiploic arteries
Blood supply of stomach: Fundus
Short gastric artery
Largest branch of the celiac trunk
Splenic artery
Largest arterial supply to the stomach and smallest branch of the celiac trunk
Left gastric artery
Venous drainage of stomach: Right and left gastric
Portal vein
Venous drainage of stomach: Left gastroepiploic and short gastric
Splenic vein to the portal vein
Venous drainage of stomach: Right gastroepiploic
Superior mesenteric to portal vein
PSY supply to the stomach (2)
1) Anterior vagal trunk from left vagus 2) Posterior vagal trunk from right vagus
PSY supply to stomach
T6-T9
Most gastric ulcers occur at
Lesser curvature, directly above the incisura
Carcinomas of the stomach are mostly found in
Distal 3rd
Distance from nasal orifices: Proximal esophageal narrowing
18 cm
Distance from nasal orifices: Middle esophageal narrowing
28 cm
Distance from nasal orifices: Distal esophageal narrowing
44 cm
Length of duodenum
25 cm
Duodenojejunal junction is seen at what level
L2
Parts of duodenum
1) Superior 2) Descending 3) Horizontal 4) Ascending
Length of part of duodenum: Superior
5 cm
Length of part of duodenum: Descending
7-10 cm
Length of part of duodenum: Horizontal
6-8cm
Length of part of duodenum: Ascending
5 cm
Level of part of duodenum: Superior
L1
Level of part of duodenum: Descending
L1-3
Level of part of duodenum: Horizontal
L3
Level of part of duodenum: Ascending
L3-2
Blood supply of duodenum: Superior part
Superior pancreaticoduodenal
Blood supply of duodenum: Inferior part
Inferior pancreaticoduodenal
Venous drainage of duodenum: Superior part
Superior pancreaticoduodenal to portal
Venous drainage of duodenum: Inferior part
Inferior pancreaticoduodenal to superior mesenteric
Duodenal ulcers most often occur at: Anterior vs posterior wall
Anterior
Perforation of ulcers most often occur at: Anterior vs posterior wall
Anterior
Blood type with increased risk of gastric ulcer
A
Blood type with increased risk of duodenal ulcer
O
Most commonly eroded artery in gastric ulcer perforation
Left gastric artery
Most commonly eroded artery in duodenal ulcer perforation
Gastroduodenal
Jejunoileal segment: Jejunal part
Proximal 2/5
Jejunoileal segment: Ileal part
Distal 3/5
Jejunoileal segment: Length
6-7 m
Quadrant: Jejunum
LUQ
Quadrant: Ileum
RLQ
Jejunum: Color
Deep red
Jejunum: Caliber
2-4 cm
Jejunum: Wall
Thick & heavy
Jejunum: Vascularity
Greater
Jejunum: Vasa rect
Long
Jejunum: Arcades
Few, large
Jejunum: Fat
Less
Jejunum: Plicae circularis
Large, tall
Jejunum: Lymphoid nodules
Few
Ileum: Color
Paler pink
Ileum: Caliber
2-3 cm
Ileum: Wall
Thin and light
Ileum: Vascularity
Less
Ileum: Vasa recta
Short
Ileum: Arcades
Many
Ileum: Fat
More
Ileum: Plicae circulares
Low, sparse, absent in distal segment
Ileum: Lymphoid nodules
Many
Instussuceptus vs intussucipiens: Proximal segment that invaginates
Instussuceptus
Instussuceptus vs intussucipiens: Distal segment that receives invaginating segment
Intussucipiens
Intussusception: Most common
Ileocecal
Intussusception: More common, children vs adult
Children
Intussusception: Signs of obstruction
1) Right-sided colicky abdominal pain 2) Abdominal distention 3) Hematochezia
Pancreas: Anterior, R to L
1) Transverse mesocolon 2) Lesser sac 3) Stomach
Pancreas: Posterior, R to L
1) Bile duct 2) Portal and splenic veins 3) IVC 4) Aorta 5) SMA 6) Left psoas 7) Left suprarenal 8) Left kidney 9) Spleen
Pancreas: Parts
1) Head 2) Neck 3) Body 4) Tail 5) Uncinate process
Pancreas: Part that overlies superior mesenteric vessels
Neck
Pancreas: Part that lies to the left of the SMA and SMV
Body
Pancreas: Part that is closely related to the hilum of the spleen and left colic flexure
Tail
Pancreas: Uncinate process projects from
Inferior part of the head
Pancreas: Uncinate process extends medially to the left, posterior to the
SMA
Main vs accessory pancreatic duct: Extends the length of the pancreas
Main
Main vs accessory pancreatic duct: Enters the duodenum
Both
Main vs accessory pancreatic duct: Joins the bile duct
Main
Main pancreatic duct joins the bile duct to form the
Hepatopancreatic ampulla
Accessory pancreatic duct lies in the
Head
Pancreas: Blood supply (3)
1) Superior pancreaticoduodenal from gastroduodenal 2) Inferior pancreaticoduodenal from SMA 3) Pancreatic arteries from splenic
Pancreatectomy: With splenic artery ligation
Warshaw technique
Pancreas: Venous drainage
Mainly into splenic vein
Most common cause of extrahepatic obstruction of biliary system
Pancreatic CA
Pancreas: Cancer of body and neck may cause obstruction of (2)
1) Portal circulation 2) IVC
Liver: Structures located posteriorly (8)
1) Diaphragm 2) Right kidney 3) Hepatic flexure of colon 4) Duodenum 5) GB 6) IVC 7) Esophagus 8) Fundus of stomach
Liver: Covered by peritoneum except at
Posteriorly, called bare area
Ligamentum teres hepatis is located between what structures
1) Left lobe 2) Quadrate lobe
Ligamentum venosum is located between
1) Left lobe 2) Caudate lobe
Liver: Anatomical lobes
1) Left 2) Right
Liver: Right lobe is divided into
Caudate and quadrate lobes
Liver: Segments
1) Medial superior I 2) Lateral superior II 3) Lateral inferior III 4) Medial inferior IV 5) Anterior inferior V 6) Posterior inferior VI 7) Posterior superior VII 8) Anterior superior VIII
Liver: Apices of cross-sections of portal lobules
Central vein
Liver: Centers of cross-sections of portal lobules
Portal triad
Portal vein is formed by union of
1) Superior mesenteric vein 2) Splenic vein
Liver: % blood supplied by portal vein
70%
Liver: Biopsy is usually done at
Right 10th ICS MAL
Gallbladder: Lies at which surface of the liver
Inferior
Gallbladder: Capacity
30-50 mL
Gallbladder: Posterior relations
1) Transverse colon 2) 1st and 2nd parts of duodenum
Gallbladder: Cystohepatic triangle
Triangle of Calot
Triangle of Calot: Boundaries
1) Superior - Liver 2) Inferior - Cystic duct 3) Medial - Common hepatic duct
Triangle of Calot: Content
Cystic artery
Cystic artery is USUALLY a branch of
Right hepatic artery
Common site of impacted gallstone
Hepatopancreatic ampulla
Impacted gallstone at hepatopancreatic ampulla: Referred pain
Epigastric region
Stone blocking the cystic duct: Characteristic pain
Biliary colic
Describe biliary colic
Begins in the epigastric region but moves to a point where 9th costal cartilage intersects the lateral border of the rectus sheath
Dermatomes of referred pain of GIT
T5-L1
Valve of Houston is associated with what organ
Rectum
