GI, USMLE Flashcards
Derivatives of foregut
Pharynx to duodenum
Derivatives of midgut
Duodenum to proximal 2/3 of transverse colon
Derivatives of hindgut
Distal 1/3 of transverse colon to rectum
Developmental defects: Failure of rostral fold closure
Sternal defects
Developmental defects: Failure of lateral wall closure
1) Omphalocele 2) Gastroschisis
Developmental defects: Failure of caudal fold closure
Bladder extrophy
Developmental defects: Failure to recanalize
Duodenal atresia
Developmental defects: Duodenal atresia is seen in what genetic disorder
Trisomy 21
Developmental defects: Due to vascular accident
Jejunal, ileal, and colonic atresia
Developmental defects: Jejunal, ileal, and colic atresia is aka
Apple peel atresia
Midgut development: Herniates through umbilical ring at
6th week
Midgut development: Returns to abdominal cavity and rotates around SMA at
10th week
Developmental defect: Extrusion of abdominal contents through abdominal folds, not covered by peritoneum
Gastroschisis
Developmental defect: Persistence of herniation of abdominal contents into umbilical cord, covered by peritoneum
Omphalocele
Gastroschisis: Constant size
Less than or equal to 5cm
Derivatives of midgut
Duodenum to transverse colon
Tracheoesophageal anomalies: Most common
EA with distal TEF
Gastroschisis: Constant location
Right of the umbilical cord
Retroperitoneal structures
SAD PUCKER 1) Suprarenal gland 2) Aorta and IVC 3) Duodenum (2nd, 3rd, and 4th parts) 4) Pancreas (except tail) 5) Ureters 6) Colon (ascending and descending) 7) Kidneys 8) Esophagus (lower 2/3) 9) Rectum (upper 2/3)
Pentalogy of Cantrell
1) Epigastric omphalocele 2) Cleft sternum 3) Anterior diaphragmatic hernia (Morgagni) 4) Absent pericardium 5) Cardiac defects (ectopia cordis/VSD)
Tracheoesophageal anomalies: Most common
EA with distal TEF
Tracheoesophageal anomalies: EA with distal TEF, signs
1) Drooling with first feeding 2) Cyanosis secondary to laryngospasm 3) Abdominal gas
Tracheoesophageal anomalies: EA with distal TEF, clinical test
Failure to pass NGT into stomach
Palpable olive in epigastric region
Hypertrophic pyloric stenosis
Hypertrophic pyloric stenosis: Characteristics of vomitus
Non-bilous, projectile, at 2 weeks of age
Hypertrophic pyloric stenosis: Treatment
Surgical incision
Pancreas: Derived from
Foregut
Ligaments: Gastrocolic ligament connects
Greater curvature of stomach and transverse colon
Pancreas: Ventral pancreatic bud abnormally encircles 2nd part of duodenum and may cause duodenal narrowing
Annular pancreas
Pancreas: Ventral and dorsal parts fail to fuse at 8 weeks
Pancreas divisum
Spleen: Derived from
Mesoderm
Blood supply: Foregut
Celiac artery
Blood supply: Midgut
SMA
Blood supply: Hindgut
IMA
Ligaments: Connects liver to anterior abdominal wall
Falciform ligament
Ligaments: Falciform ligament, content
Ligamentum teres hepatis
Ligaments: Connects liver to duodenum
Hepatoduodenal ligament
Ligaments: Hepatoduodenal ligament, contents
Portal triad
Portal triad
1) Portal vein 2) Hepatic artery 3) Common bile duct
Ligaments: Hepatoduodenal ligament, compressed between thumb and index finger in the omental foramen to stop bleeding
Pringle maneuver
Ligaments: Liver to lesser curvature of stomach
Gastrohepatic ligament
Ligaments: Gastrocolic ligament connects
Greater curvature of stomach and transverse colon
Ligaments: Gastrocolic ligament, content
Gastroepiploic arteries
Ligaments: Gastrosplenic ligament connects
Greater curvature of stomach and spleen
Ligaments: Gastrosplenic ligament, content
1) Short gastrics 2) Left gastroepiploic vessels
Ligaments: Spleen to posterior abdominal wall
Splenorenal ligament
Ligaments: Splenorenal ligament, contents
1) Splenic artery and vein 2) Tail of pancreas
Derivatives of ventral pancreatic bud
1) Head 2) Main pancreatic duct 3) Uncinate process
Layers of gut wall: Erosion extends up to
Mucosa
Layers of gut wall: Ulcer extends up to
Submucosa
Frequency of slow waves: Duodenum
12/min
Frequency of slow waves: Ileum
8-9/min
Histology: Esophagus
Nonkeratinizing stratified squamous epithelium
Histology: Stomach
Gastric glands
Histology: Duodenum
Villi and microvilli
Histology: Location of Brunner’s glands
Submucosa of duodenum
Histology: Location of crypts of Leiberkuhn
1) Duodenum 2) Jejunum 3) Ileum
Histology: Plica circulares
1) Jejunum 2) Proximal ileum
Histology: Peyer’s patches
Lamina propria and submucosa of ileum
Histology: Contains largest number of goblet cells in the INTESTINE
Ileum
Histology: Colon
1) Crypts without villi 2) Goblet cells
Branches of abdominal aorta in order downwards (10)
1) Inferior phrenic artery 2) Celiac trunk 3) Left middle suprarenal artery 4) SMA 5) Right and left renal arteries 6) Left testicular/ovarian artery 7) Right testicular/ovarian artery 8) IMA 9) Bifurcation: Left and right common iliac 10) Median sacral artery
Transverse portion of duodenum (3rd part) is entrapped between SMA and aorta causing intestinal obstruction
SMA syndrome
Vertebral levels: Celiac trunk
T12
Vertebral levels: SMA
L1
Vertebral levels: Left renal artery
L1
Vertebral levels: IMA
L3
Vertebral levels: Bifurcation of abdominal aorta
L4
Watershed region
Splenic flexure
Main blood supply of stomach
Celiac trunk
Branches of celiac trunk
1) Common hepatic 2) Splenic 3) Left gastric
Sites of portosystemic anastomoses
1) Esophagus 2) Umbilicus 3) Rectum
Clinical signs of portal hypertension based on anastomoses
1) Esophageal varices 2) Caput medusae 3) Internal hemorrhoids
Portal-systemic: Esophagus
Left gastric-esophageal
Portal-systemic: Umbilicus
Paraumbilical-superficial and inferior epigastric, superior epigastric, lateral thoracic
Portal-systemic: Rectum
Superior rectal-middle and inferior rectal
Portal hypertension, management: Shunts blood to systemic circulation
TIPS
Hindgut: Derived from
Endoderm
Where endoderm and ectoderm meet
Pectinate/dentate line
Above pectinate line: Internal vs external hemorhhoids
Internal
Above pectinate line: Arterial supply
Superior rectal from IMA
Above pectinate line: Venous drainage
Superior rectal- Inferior mesenteric - Portal system
Above pectinate line: Lymphatic drainage
Deep nodes
Above pectinate line: Carcinoma
Adenocarcinoma
Below pectinate line: Internal vs external hemorrhoids
External
Below pectinate line: Carcinoma
Squamous cell carcinoma
Below pectinate line: Arterial supply
Inferior rectal from internal pudendal
Below pectinate line: Venous drainage
Inferior rectal-internal pudendal-internal iliac-IVC
Below pectinate line: Lympatic drainage
Superificial inguinal nodes
Innervation: Internal hemorrhoids
Visceral
Innervation: External hemorrhoids
Somatic
Apical surface of hepatocytes face
Bile cannaliculi
Basolateral surface of canaliculi face
Sinusoids
Liver: Sinusoids drain into
Central vein
Liver: Central vein drains into
Hepatic veins-systemic circulation
Liver: Zones
1) I, periportal 2) II, intermediate 3) III, pericentral vein or centrilobular
Liver: Blood flow through zones
I-II-III