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GI- Witwer Flashcards

1
Q

What is the visceral peritoneum?

A

Covers the organs (sensitive to the stretching of organs)

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2
Q

What is the parietal peritoneum?

A

Lines the walls of the abdominal and pelvic cavities (can sense pain)

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3
Q

Pain in the abdomen is poorly localized which causes ________ pain elsewhere in the body

A

referred

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4
Q

Intraperitoneal organs are ones that are…

A

Completely surrounded by peritoneum

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5
Q

Retriperitoneal organs are ones that…

A

Peritoneum only covers the anterior surface and doesn’t wrap around them like in intraperitoneal organs

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6
Q

What are the intraperitoneal organs?

A
  • stomach
  • the first five centimeters and the fourth part of the the duodenum
  • the jejunum
  • the ileum
  • the cecum
  • the appendix
  • transverse colon & sigmoid colon
  • upper third of the rectum
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7
Q

What are the retroperitoneal organs?

SAD PUCKER

A 
S- Suprarenal (adrenal glands)
A- Aorta 
D- Duodenum 
P- Pancreas (except the tail)
U- Ureters 
C- Colon (ascending and descending)
K- Kidneys 
E- Esophagus
R- Rectum
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8
Q

What is the portal triad (porta hepatus)?

A

Hepatic portal vein, portal vein and common bile duct

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9
Q

What is the importance of the ligament of treitz?

A

It is a landmark: for the radiological diagnosis of intestinal malrotation and partial rotation. for discriminating between upper and lower gastrointestinal bleeding.

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10
Q

What is morissons pouch and what is the significance?

A

Morison’s pouch is an area between your liver and your right kidney. Morison’s pouch is a potential space that can open up when fluid or blood enters the area. When these aren’t present, there’s no space between your liver and right kidney. As a result, doctors use the presence of Morison’s pouch on an ultrasound to help diagnose conditions that cause fluid buildup in your abdomen.

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11
Q

What is the pouch of douglas and its significance?

A

It is an extension of the peritoneal cavity between the rectum and the posterior wall of the uterus in the female human body. When you are standing its the lowest. It is is a common site for the spread of pathology such as ascites, tumor, endometriosis, pus, etc.

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12
Q

The esophagus has _________ muscle control, not conscious control and is triggered by the _______ reflex

A

skeletal, swallow

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13
Q

What nerve is around the esophagus and what happens when it is cut?

A

Vagus and bulbar paralysis

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14
Q

Eosinophilic esophagitis is an ________ condition that can cause dysphagia, gastroesophageal reflux and food impaction

A

allergic inflammatory

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15
Q

birds beak on xray is

A

achalasia

your LES fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your esophagus.

Can be secondary to esophageal cancer or chaga’s dz

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16
Q

A gastric ulcer is serious for what reason?

A

It can erode all the way through the stomach and you get perf then there is scarring

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17
Q

What are the fat soluble vitamins?

A

DEAK

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18
Q

What is an ileus?

A

MED EMERGENCY
Ileus is a temporary arrest of intestinal peristalsis. It occurs most commonly after abdominal surgery, particularly when the intestines have been manipulated. Symptoms are nausea, vomiting, and vague abdominal discomfort.

Basically paralysis/non-function of bowel

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19
Q

Why is the mesenteric artery important or rather the blood flow in that region?

A

It has extensive anastimoses between the celiac artery and the superior mesenteric artery so that if one area is blocked, there is still blood flow to other areas of the abdomen

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20
Q

What disease causes the “string sign’ on xray

A

Chron’s disease

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21
Q

How are diseases of the esophagus diagnosed?

A

Upper GI series (barium study) or CT

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22
Q

What is Barrett’s esophagus and why is it important?

A

Esophageal squamous epithelium changes (metaplasia) to columnar epithelium in patients with GERD predisposing the patient to an increased risk of esophageal cancer.

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23
Q

Esophageal varies can be found in patients with _______ ________

A

portal hypertension

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24
Q

What is a hiatus hernia?

A

Hiatus Hernia – can be sliding and reducible, or fixed. Associated with GERD and dysphagia (obstructive).

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25
The Schatzki Ring is a type of _____ hernia.
hiatus
26
A term used for an abnormal propulsive activity of the intestines. This can be either an increased activity or decreased or absent intestinal activity.
Ileus
27
What is an obstructive ileus?
In Obstructive ileus, initially the bowel has increased activity, strongly contracting to overcome the obstruction. This results in active bowel and fluid sounds on auscultation. In long standing obstruction, the bowel activity can become decreased.
28
In obstructive ileus, the bowel initially has ________ activity to overcome the obstruction
increased
29
In obstructive ileus, the bowel initially has ________ activity to overcome the obstruction
increased **Secondary to mechanical obstruction, either secondary to adhesions, tumor, volvulus
30
Ileus can also be called a paralytic ileus and cause ________ intestinal activity
decreased **Secondary to appendicitis, cholecystitis, pancreatitis, etc or other condition such as post surgical, diabetes or low potassium causing intestinal lack of tone
31
What is a paralytic ileus?
Or Ileus can be secondary to an intra-abdominal inflammatory process such as appendicitis, cholecystitis, pancreatitis, etc or other condition such as post surgical, diabetes or low potassium causing intestinal atony or paralysis resulting in decreased intestinal activity and is called Paralytic Ileus In Paralytic Ileus there are diminished or absent bowel sounds.
32
An xray of obstructive and paralytic ileus will both show _________ so dx is really based on hx and physical exam
Be dilated air filled loops of bowel and air-fluid levels in the bowel when the patient is upright
33
Why does the appendix get infected?
There is no place for the pus to go
34
What is a small bowel rotation (intestinal rotation)?
A birth defect in which the intestines do not correctly or completely rotate into their normal final position during development. The way in which it twists blocks the intestines.
35
At which age does a midgut volvulus typically occur?
Kids
36
At which age does a midgut volvulus typically occur?
Within one month of birth
37
What is a midgut volvulus?
a complication of malrotated bowel. It may result in proximal bowel obstruction with resultant ischemia if prompt treatment is not instigated. I think a small bowel rotation causes a midgut volvulus
38
Bile stained emesis and tenting of skin in a newborn is a sign of what?
Intestinal obstruction (mid gut volvulus)
39
Cholelithiasis causes ______ _______ on xray
Acoustic shadowing
40
You can cut the ______ of _____ which allows drainage of gall stones into the duodenum
spinchter of ode
41
_______ is initial diagnostic modality to determine presence of stones and thickness of GB wall. Most commonly, the cystic duct is obstructed by a stone or inflammation.
U/S
42
What is acalculous cholecystitis
Means without stones
43
Gallstones can move into the ______ _____ ____causing obstruction of the Common Bile Duct and Pancreatic Duct (the latter can be a cause of Pancreatitis)
Common bile duct
44
When a patient has had a prior surgery, obstruction is usually secondary to an ________. When no prior surgery, think _________ obstruction of the bowel.
Adhesion, malignant
45
__________ can cause a pseudo-obstruction of the bowel, dilation and loss of motility
Hypokalemia This is Ogilvie's syndrome
46
What is the mc liver tumor?
Cavernous hemangioma which is a tumor of the blood vessels. We should not do a bx on this or else it will rupture and bleed out
47
This is a regenerative mass lesion of the liver and the second most common benign liver lesion
Focal Nodular Hyperplasia- there is a possible association with oral contraceptives
48
What is hemachromatosis of the liver?
Secondary to multiple transfusions or metabolic abnormality. Accumulation of iron from RBCs= dense liver that becomes cirrhotic
49
What is the difference between painful and painless jaundice?
Painful obstructive jaundice obstructing the common duct where it joins the duodenum is usually related to gallstones (causes steatorrhea-clay colored stools), while painless obstructive jaundice tends to be related to tumours. The reason for this difference is that stones tend to harbour bacteria and cause bile duct infection, resulting in pain and fever.
50
What are the main causes of cirrhosis?
The most common causes of Cirrhosis are Hepatitis C, Alcohol-related Liver Disease, Non-Alcoholic Fatty Liver Disease, and Hepatitis B. *Hep C and alcoholism are #1
51
This triad of fulminating peptic ulcer disease, gastric acid hypersecretion and non-beta islet cell tumors of pancreas is for what condition?
Zollinger-Ellison syndrome (basically oversecretion of gastrin and HCl which leads to peptic ulcer disease)
52
What are two most common causes of pancreatitis?
Having gallstones and drinking a lot of alcohol are the two most common causes of pancreatitis.
53
What is chronic pancreatitis and what happens?
Chronic Pancreatitis, scarring, Pseudocyst formation (mass effect), loss of functioning tissue
54
What is McBurney’s Point and Aaron’s Sign?
Aaron sign is referred pain felt in the epigastrium upon continuous firm pressure over McBurney's point, indicative of chronic appendicitis.
55
What is the presentation of pancreatitis? What do they mean?
Initial peri-umbilical pain and subsequent right lower quadrant pain. Presumably because of distension of the appendix.
56
Where does the Common Bile Duct and Pancreatic Duct enter the Duodenum?
Ampulla of Vater
57
What is a common cause of duodenal ulcer?
H. pylori
58
What is the foregut, midgut and hindgut
Foregut- toward the mouth Midgut- intestines Hindgut- transverse colon and the splenic flexure, the descending colon, sigmoid colon and rectum
59
Why is celiac disease (non-typical sprue) a don't forget?
Malabsorption can mask as a wasting disease of unknown etiology.
60
Understand the hepatic portal system
The hepatic portal system connects the capillaries of the gastrointestinal tract with the capillaries in the liver.
61
Know what portal hypertension is in regards to cirrhosis
Portal hypertension is a leading side effect of cirrhosis. Your body carries blood to your liver through a large blood vessel called the portal vein . Cirrhosis slows your blood flow and puts stress on the portal vein. This causes high blood pressure known as portal hypertension.
62
Diverticulosis vs diverticulitis
``` Diverticulosis= multiple outpouches in the large bowel (mc sigmoid colon) Diverticulitis= the diverticuli openings can get blocked and can lead to inflammation ``` **Cramping, non-descript, visceral type pain Uncomplicated is no abscesses, no fissures, no fistula. Complicated is abscess and fistula formation
63
What imaging do you get for diverticulitis?
CT
64
Some patients with diverticulitis can get a _____ carcinoma and these patients will need this type of imaging
colon & colonoscopy
65
Current jelly stools
Mmmmm Mmmmm - Intussusception
66
How is Intussusception dx and treated?
Diagnosed with Ultrasound and treated with an barium or water soluble contrast enema
67
What is intussusception?
A portion of the small bowel (intussusceptum) intussuscepts into more distal bowel (intussuscipiens)
68
What is Pseudomembranous Colitis and what causes it?
overgrowth of C. diff b/c of use of abx
69
In Pseudomembranous colitis, what will you see on xray?
Thumbprinting indicating bowel wall edema
70
Scarring and "pipe like" colon that has a high incidence of adenocarcinoma
Ulcerative colitis
71
Toxic megacolon is a complication of what?
Ulcerative colitis | *Distended w/ lots of pain
72
Apple core lesion (narrowed lumen of the colon)
Carcinoma of the Colon
73
Whenever you see a large dilated loop of bowel, what should you think of?
Volvulus
74
An ER FAST scan U/S looks for
free blood and possible end organ damage in four places: 1. Morrisons pouch 2. Pericardium 3. Blood in spleen 4. Blood in pouch of douglas

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