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Gastrointestinal System > High yield GIT > Flashcards

High yield GIT Flashcards

0
Q

Gall stones ( cholelithiasis )

A

Conjugated ( direct ) bilirubin - elevated

Unconjugated ( indirect ) - normal or slightly elevated

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1
Q

Cirrhosis of liver !!

A

Jaundice or icterus - due to excess of conjugated ( direct ) bilirubin
Ascites - due to portal HTN , low plasma colloid osmotic pressure ( also peripheral edema )
Esophageal varices - due to portal HTN of azygous veins

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2
Q

Foregut

A

Ends anatomically at ampulla of vater .
Foregut derivatives are supplied by celiac artery except esophagus .
Intra abdominal part of esophagus - celiac trunk
Intra thoracic part - other branches of aorta

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3
Q

Clinical correlations of the esophagus !!

A

1) esophageal atresia - tracheoesophageal septum deviates and causes closure of esophagus . Congenital defects ass with Vater and Vacterl syndrome . Clinically ass with poly hydromnios ( unable to swallow amniotic fluid) and tracheoesophageal fistula .
2) esophageal stenosis - involves mid esophagus . May be caused by submucosal / muscularis externa hypertrophy , remanants of tracheal cartilaginous rings in the wall of eso , membranous diaphragm obstructing the lumen of eso .

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4
Q

Esophagus

A

3 ) esophageal duplication - occurs due to congenital cyst in the lower esophagus . In the posterior wall where they protrude in to post mediastinum or wall of esophagus ( intramural )

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5
Q

Esophagus

A

Vascular compression of esophagus - occurs when there is an abnormal origin of rt subclavian artery . This may cause dysphagia ( dysphagia lusoria)

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6
Q

Tracheoesophageal fistula

A

Abnormal communication btwn trachea and esophagus due to improper dividion of foregut by tracheoesophageal fistula . Ass with esophageal atresia and polyhydromnios .
C/F :
Excessive accumulation of saliva or mucous in nose and mouth ; gagging n cyanosis after swallowing milk; abdominal distension after crying ; reflux of gastric contents in to lungs - pneumonitis.
Diagnostic findings:
Inability to pass catheter in to stomach ;
Radiograph - air in infants stomach

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7
Q

Stomach

Hypertrophic pyloric stenosis

A

Muscularis externa in pyloric region hypertrophies causing narrow lumen that obstructs food .
C/F :
Projectile non - bilious vomiting after feeding ; small palpable mass at rt coastal margin ; increased incidence in infants treated with erythromycin

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8
Q

Liver

A

Week 6 - liver begins hematopoiesis

Week 12 - bile production

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9
Q

Biliary atresia

A

Obliteration of extrahepatic or / and intrahepatic ducts . Ducts are replaced by fibrotic tissue because of acute and chronic inflammation .
C/F :
Progressive neonatal jaundice , white clay colored stool , dark colored urine
Survival rate - 12 to 19 months

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10
Q

Islet cells ( endodermal )

A

Alpha cells - glucagon
Beta cells - insulin
Delta cells - somatostatin
PP cells - pancreatic polypeptide

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11
Q

Annular pancreas

A

Ventral pancreatic bud fuses with dorsal . Forms ring of pancreatic tissue around the duodenum and obstruction . C/F :
Newborns n infants are intolerant to oral feeding ; bilious vomiting ;
Radiograph :
Double bubble sign - dilatation of stomach n distal duodenum

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12
Q

Midgut

A

Lower duodenum ; jeju : ileum ; caecum ; appendix ; asc colon : prox 2/3 of transverse colon . Supplied by sup mesenteric artery

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13
Q

Duodenal atresia

A 
Lumen of the duodenum is occluded as a result of failed recanalization . 
C/F : 
Polyhydromnios 
Bile containing vomitus 
Distended stomach
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14
Q

Omphalocele

A

Abdominal contents protruding out frm the base of umbilical cord . Ass with trisomy 13 , 18 or beckwith wiedemann syndrome

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15
Q

Malrotation of the midgut

A

Clinical complication - volvulus ( twisting of small intestine )

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16
Q

Ileal diverticulum ( meckel diverticulum )

A

Remnant of vitelline ducts persists . Forms an outpouching on antimesenteric border of ileum . Outpouching connects to umbilicus vua fibrous cord or fistula .

C/F:
Heterotrophic fibrous mucosa , ulceration , perforation , gastrointestinal bleeding ( if large no of parietal cells present ) ; symptoms resemble appendicitis and bright red or dark red stools ( bloody )

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17
Q

Abdominal mass , bouts of abdominal pain , vomiting , chronic rectal bleeding , intussusception N perforation .

A

Duplication of intestines

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18
Q

2 years old , acute onset intermittent abdominal pain , vomiting , bloody stools , diarrhea and somnolence

A

Intussusception - segment of bowel invaginates in to adjacent bowel segments leading to obstruction or ischemis

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19
Q

Normal appendix - medical to cecum

A

Retrocecal or retrocolic appendix - appendix on posterior side of caecum

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20
Q

Hindgut

A

Distal 1/3 of trans colon ; desc colon ; sigmoid colon ; rectum ; upper anal canal

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21
Q

Colonic aganglionosis ( hirschsprung disease)

A

Arrest of caudal migration of neural crest cells .
Hallmark - absence of ganglionic cells in the myenteric and submucosal plexuses most commonly in the sigmoid colon and rectum resulting in a narrow segment of colon ( colon fails to relax)

Characteristic functional finding - failure of internal anal sphincter to relax following rectal distention ( abnormal rectoanal reflex)

C/F:
Distended abdomen
Inability to pass meconium
Gushing of fecal material upon a rectal digital exam .
Loss of peristalsis in the colon segment distal to normal innervated colon.

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22
Q

Ectopic anus ( imperforate anus )

A

2 types

1) hindgut ends ABOVE puborectalis muscle ( anorectal agenesis ) - puborectalis muscle is hypoplastic or absent
2) hindgut BELOW the muscle (anal agenesis) - muscle well dev n fuctional

23
Q

In ectopic anus , the anus opens through various fistulas

A 
Female - 
Anoperineal fistula 
Rectovestibular fistula ( common) 
Low rectovaginal fistula 
High rectovaginal fistula 
Rectocloacal fistula 
Male - 
Anoperineal fistula 
Low rectourethral fistula 
High rectourethral fistula 
Rectovesical fistula
24
Q

Embryonic mesentery consists of

A

Ventral mesogastrium

Dorsal mesentery

25
Q

Embryonic ventral mesogastrium

A

Adult - lesser omentum ( hepatogastric n hepatoduodenal ligaments ) , falciform ligament , coronary ligament of the liver , triangular ligaments of the liver

26
Q

Embryonic dorsal mesentery

A

Adult - greater omentum ( gastrorenal , gastrosplenic , gastrocolic , splenorenal ligaments) messntery of small intestine , mesoappendix , trans mesocolon , sigmoid mesocolon

27
Q

Abdominal aorta branches

A 
1 . Celiac trunk 
2 . Sup mesenteric artery 
3 . Renal arteries 
4 . Gonadal arteries 
5 . Inf mesenteric artery 
6 . Common iliac artery
28
Q

Celiac trunk

A

T12 vertebrae
a. Left gastric artery - runs along the lesser curvature of stomach n anastomoses with rt gastric artery and gve rise to esophageal n hepatic branches

B. Splenic artery - runs along the superior border of pancreas

  1. dorsal pancreatic artery
  2. short gastric arteries
  3. left gastroepiploic arteries
C. Common hepatic artery - run along the sup border of pancreas 
1. Proper hepatic artery 
                |
   Rt n lft hepatic artery 
     |
 Cystic artery ( gallbladder) 
2.rt gastric artery 
3.gastroduodenal artery
29
Q

Sup mesenteric artery - L1 vertebrae

A
  1. Inf pancreaticoduodenal artery
  2. middle colic artery
  3. Rt colic artery
  4. Ileicolic artery
  5. intestinal arteries
30
Q

Inf mesenteric artery - L3 vertebrae

A
  1. lft colic artery
  2. sigmoid arteries
  3. sup rectal arteries
31
Q

Abdominal aortic aneurysm

A

Atherosclerotic elderly males below L1 vertebral level (below renal and sup mesenteric artery)

32
Q

The most common site of ruptured AAA ?

A

Below the renal arteries in the left posterolateral wall (retroperitoneal)

33
Q

Which artery lied in the middle of AAA ?

A

Inf mesenteric artery

34
Q

C/F of AAA ?

A

Severe central abdominal pain ,
Radiate to back , pulsatile tender abdominal mass , if ruptures - hypotension and delirium may occur .

Surgical complications - ischemic colitis due to ligation of the inf mesenteric artery or spinal cord ischemia due to ligation of the great radicular artery .

35
Q

Routes of collateral venous return exist in case the IVC is blocked by either a malignant retroperitoneal tumor or a large blood clot (thrombus)

A

A. Azygous vein => SVC => rt atrium

B. Lumbar veins => external n internal vertebral venous plexuses =>cranial dural sinuses => internal jugular veins => rt atrium

36
Q

If the site of anastomoses is Esophagus and clinical sign is esophageal varices .

Veins involved in portal inf venal caval anastomosis ?

A

Left gastric vein esophageal vein

37
Q

If umbilicus is the site of anastomosis . What is the clinical sign n veins involvdd ?

A

Caput medusa

Paraumbilical vein sup and inf epipastric veins

38
Q

If site of anastomoses is rectum . What is the clinical sign ?

A

Anorectal varices .

Sup rectal vein middle n inf rectal vein

39
Q

Vomit copious amounts of blood , alcoholism , liver cirrhosis , schistosomiasis , enlarged abdomen due to ascitis , splenomegaly

A

Portal HTN

40
Q

Constrictions along the course of esophagus

A
  1. at the junction of pharnyx and esophagus (cricoid origin)
  2. at aortic arch
  3. at the tracheal bifurcation (T4) where the left main bronchus crosses esophagus
  4. left atrium
  5. esophageal hiatus
41
Q

Which structure separated pharnyx from esophagus

A

Upper eaophageal sphincter

42
Q

Opening muscles of upper esophageal sphincter

A

Thyrohyoid

Geniohyoid

43
Q

Closing muscles of upper esophageal sphincter

A

Inf pharangeal constrictor and cricopharyngeus(main player)

UES is skeletal muscle

44
Q

Which structure separates esophagus frm stomach

A

Lower esophageal sphincter

45
Q

In human autopsies asymmetric , thickened , ringlike area in the area of the gastroesophageal junction which may aid the muscularis externa in the physiological role as sphincter

A

Lower esophageal sphincter , smooth muscle , prevents gastroesophageal reflux

46
Q

Arterial and venous drainage of cervical esophagus

A

A - inf thyroid artery

V- inf thyroid veins

47
Q

A and v of thoracic esophagus

A

A- 4-5 branches of descending thoracic aorta

V - esophageal plexus of veins

48
Q

Abdominal esophagus

A

A - left gastric artery

V - lft gastric vein

49
Q

Progressive dysphagia n difficulty swallowing . Barium swallow shows dilated esophagus above the LES and distal stenosis at LES ( bird beak appearance )

A

Achalasia . Occurs due to loss of ganglion cells in myenteric plexus of auerbach n is characterised by failure to relax LES .

Chagas disease caused by trypanosoma cruzi may lead to achalasia

50
Q

What happens to esophagus during bronchogenic carcinoma

A

Indent the esophagus due to enlargement of mediastinal lymph nodes . Observed with barium swallow

51
Q

Malignant tumors of esophagus

A

Occur in the lower 1/3rd of eso n metastasize to celiac lymph nodes

52
Q

Stomach along the gastroesophageal junction herniates through diaphragm in to thorax .

A

Sliding hiatal hernia .
Deep burning retrosternal pain and reflux of gastric contents in to mouth (heartburn) which are accentuated in supine position

53
Q

Stomach herniates through the diaphragm in to thorax

A

Paraesophageal hiatal hernia .

No reflux of gastric contents but strangulation or obstruction may occur

54
Q

Esophageal varices

A

Dilated subepithelial and submucosal venous plexuses of the esophagus that drain in to left gastric (coronary) vein .

The lft gastric vein empties in to portal vein from the distal esophagus and proximal stomach .

Esoph varices are caused by portal HTN .

Portal HTN caused by - 
Intrahepatic events ( cirrhosis , schistosomiasis , sarcoidosis )

Prehepatic events - ( portal vein thrombosis , increases splenic flow)

Posthepatic events - vena cava obstruction , budd - chiari syndrome , veno- occlusive disease

Gastrointestinal System (2 decks)

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