L7 - GI System II

Question 1

What is the muscular consistency of the esophagus?

Answer 1

Upper 1/3 - skeletal muscle
Middle 1/3 - mixed skeletal and smooth muscle
Lower 1/3 - smooth muscle

Question 2

There are four constriction points of the esophagus, where are they? Why are they clinically significant?

Answer 2

1) where the pharynx meets the esophagus
2) at the left main bronchus
3) where the aortic arch crosses
4) at the level of the diaphragm

They are significant because it is where you are most likely to find stuck food boli (?)

Question 3

What part of the stomach would you find the gastric bubble?

Answer 3

The fundus

Question 4

What part of the duodenum neutralizes the acidic chyme of the stomach? Why is this clinically significant?

Answer 4

Acidic chyme is neutralized in the second part of the duodenum. This makes the duodenal bulb prone to ulcers

Question 5

What are the longitudinal folds of the stomach called? What do these allow the stomach do?

Answer 5

Folds are called rugae and they allow the stomach to expand

Question 6

What is the cause of gastric outlet syndrome?

Answer 6

Obstruction or compression of the pylorus

Question 7

Which two arteries form an anastomosis on the lesser curvature of the stomach?

Answer 7

Left and right gastric artery

Question 8

What is the tortuous artery that comes off the celiac artery and passes behind the stomach?

Answer 8

Splenic artery

Question 9

Which arteries come off the splenic artery and supply the fundus of the stomach?

Answer 9

Short gastric arteries

Question 10

The common hepatic artery serves which structures?

Answer 10

Liver and gallbladder

Question 11

The common hepatic artery splits into which two arteries?

Answer 11

proper hepatic artery and gastroduodenal

Question 12

The celiac trunk forms an anastomosis with the SMA, how?

Answer 12

Celiac trunk –> Common hepatic –> Gastroduodenal –> Anterior and posterior branches of the superior pancreaticoduodenal artery –> Anterior and posterior branches of the inferior pancreaticoduodenal artery –> Superior mesenteric artery

Question 13

The veins of the foregut all eventually drain where? Which two veins drain directly?

Answer 13

1) portal system

2) left and right gastric vein

Question 14

Which veins drain into the splenic vein?

Answer 14

Short gastric and left gastro-omental vein

Question 15

If there is a perforation of a peptic ulcer on the posterior wall of the stomach, where will stomach contents spill into?

Answer 15

Lesser sac

Question 16

What are the endpoints of the small intestine?

Answer 16

From the pyloric orifice to the ileocecal junction

Question 17

What are the four parts of the duodenum?

Answer 17

1) superior
2) descending
3) transverse
4) ascending

Question 18

Where in the peritoneum are the four parts of the duodenum?

Answer 18

1st part is intraperitoneal

2nd, 3rd, and 4th are retroperitoneal

Question 19

Which section of the duodenum has no plicae? Which section lies directly against the aorta and IVC? Which portion is anchored to the diaphragm by the Ligament of Treitz?

Answer 19

1) first portion
2) third portion
3) fourth position

Question 20

What portions does the ligament of Treitz separate?

Answer 20

Upper GI from lower GI segments

Question 21

Are the arterial arcades in the jejunum widely spaced or narrow? Are the vasa rectae short or long?

Answer 21

Long vasa rectae and widely-spaced arterial arcades

Question 22

What part of the small intestine after the duodenum is jejunum? Ileum?

Answer 22

Jejunum is proximal 2/5th, whereas ileum is distal 3/5ths

Question 23

Is the ileum smooth-appearing or “feathery”?

Answer 23

Smooth appearance

Question 24

Where does the appendix initially refer pain? Once it progresses where is the pain?

Answer 24

Initially may be periumbilical, then localizes in the RLQ

Question 25

Where exactly is McBurney’s point and what does it signify?

Answer 25

2/3rds the distance along the line from the umbilicus to the anterior superior iliac spine. Surface landmark for the appendix

Question 26

What is rebound tenderness?

Answer 26

When pain is elicited more so upon release of palpation from an abdominal area

Question 27

What is rebound tenderness an indication of?

Answer 27

Peritonitis

Question 28

What is psoas sign?

Answer 28

Stretching of the psoas major muscle causes irritation of the retroperitoneal lining/appendix when there is infection

Question 29

Where in the abdomen are SBOs usually located?

Answer 29

Centrally

Question 30

What appearance to the plicae seminlunaris take when there is a SBO present?

Answer 30

“stack of coins” appearance

Question 31

What are some symptoms of an SBO?

Answer 31

• abdominal distension and pain
• increased bowel sounds
• vomiting
• constipation
• no flatulence per rectum

Question 32

What are the five main tributaries of the SMA?

Answer 32

1) jejunal
2) ileal
3) ileo-colic
4) right colic
5) middle colic