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*GIGU I > Lecture 4 & 6: Organs of the GI tract > Flashcards

Lecture 4 & 6: Organs of the GI tract Flashcards

1
Q

The esophagus enters the abdomen at which costal cartilage and vertebral level; through which opening?

A

Tip of the left 7th costal cartilage at T10; the esophageal hiatus

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2
Q

The esophagus enters the stomach at which costal cartilage at what spinal level?

A

Tip of the left 8th costal cartilage at T11

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3
Q

The pylorus of the stomach is in which plane and spinal level?

A

Transpyloric plane; L1

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4
Q

What are the constrictions of the esophagus?

A
  1. Cervical constriction (upper esophageal sphincter)
  2. Thoracic (broncho-aortic) constriction
  3. Diaphragmatic constriction (lower esophageal sphincter)
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5
Q

The what forms the cervical constriction and thoracic constriction of the esophagus?

A
  • Cervical (upper) = Cricopharyngeus m.
  • Thoracic (broncho-aortic) = left main bronchus
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6
Q

What are the 2 types of Hiatal Hernias?

A

1) Para-esophageal hernia
2) Sliding hiatal hernia

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7
Q

What are the characteristics of a Para-esophageal hernia?

A
  • Cardia of stomach in normal position, but peritoneum and fundus anterior to esophagus
  • No regurgitation
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8
Q

What are the characteristics of a Sliding Hiatal Hernia?

A
  • Most common
  • Esophagus, cardia, and fundus through hiatus
  • Especially bad when laying down/bent over
  • Regurgitation
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9
Q

What quadrants does the stomach lie in?

A

RUQ and LUQ

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10
Q

What are the spinal levels of the stomach?

A
  • Left end fixed at T10-T11
  • Right end fixed at L1
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11
Q

Is stomach intraperiotneal or retro-?

A

Intraperitoneal

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12
Q

What is found anterior to the stomach (relationships)?

A
  • Anterior Abdominal Wall
  • Diaphragm
  • Left lobe of liver
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13
Q

What is found posterior to the stomach (relationships)?

A
  • Diaphragm
  • Spleen (posterior and lateral)
  • Left suprarenal gland
  • Left upper kidney
  • Pancreas
  • Transverse colon (inferior and lateral)
  • Transverse mesocolon
  • Omental bursa
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14
Q

Where does the Duodenum begin and end (strucutres and spinal levels)?

A

Begins at pylorus (L1), ends at duodenojejunal flexure (L2)

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15
Q

Which parts of the duodenum are intraperitoneal and which are retroperitoneal?

A
  • First part = intraperitoneal
  • 2nd-4th parts = retroperitoneal
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16
Q

What is the important ligament in the 1st part of the duodenum; why?

A
  • Hepatoduodenal ligament (lesser omentum)
  • Contains the Portal triad
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17
Q

What makes up the portal triad?

A

1) Portal vein
2) Hepatic artery
3) Bile duct

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18
Q

Whats significant about the second part of the duodenum?

A

Where the bile duct and pancreatic duct enter, so this is where bile will start to be found within the GI tube

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19
Q

The bile and pancreatic duct meet up and enter the second part of the duodenum through which strucutre, this forms the?

A

Converge and together through a common hepatopancreatic ampulla and form the major duodenal papilla (of Vater)

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20
Q

Where do the SMA and SMV lie in relation to the pancreas and duodenum?

A
  • Lie posterior to the pancreas and cross the 3rd part of duodeum anteriorly
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21
Q

What is the suspensory ligament of the duodenum (of Treitz)?

A

Anchors 4th part of duodenum to right crus of the diaphragm

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22
Q

What quadrant is the Jejunum in, makes up how much of small intestine?

A

LUQ; 2/5 of the small intestine

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23
Q

What quadrant is the Ileum in, makes up how much of small intestine?

A

RLQ; 3/5 of small intestine

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24
Q

What are distinguishing features of the Jejunum (arcades, vasa recta, vascularity, wall)?

A
  • Few/lareger arcades
  • Long vasa recta
  • More vascular
  • Thicker and greater diameter
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25
Q

What are distinguishing features of the Ileum (arcades, vasa recta, vascularity, wall)?

A
  • Many/short arcades
  • Shorter vasa recta
  • Less vascular
  • Smaller diameter; thinner walls
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26
Q

How do they Peyer’s patches differ in the Jejunum vs Ileum?

A

Jejunum = Few Peyer’s patches

Ileum = Many Peyer’s patches

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27
Q

What are the Plicae Circulares like from the proximal jejunum to terminal ileum?

A

Proximal jejunum = More plicae circulares

Terminal ileum = Very few plicae circulares

28
Q

What is the ileocolic junction and what spinal levels does it occupy (what type of peritoneal)?

A
  • Where ileum meets the cecum at L5 and goes down to S2 (intraperitoneal)
29
Q

What are the spinal level boundaries of the ascending colon and where does it stop (type of peritoneal)?

A

Starts at L5 and moves up to the transpyloric plane at L1, stops at the hepatic flexure (left colic).

* Secondarily Retroperitoneal*

30
Q

Where does the transverse colon start and stop (spinal levels), and type of peritoneal?

A
  • Starts at L1 and come across to end at the left colic (splenic) flexure at T12
  • Intraperitoneal
31
Q

What is the transverse colon attached to the wall by?

A

Transverse mesocolon

32
Q

Describe the path of the descending colon w/ spinal levels and structures, type of peritoneal?

A

Starts at right colic (splenic) flexure at T12 and descends to about the crest of the hips at L4, before deviating medially (secondarily retroperitoneal)

33
Q

What structure lies inferior to the 1st part of the duodenum?

A
  • Head of pancreas
34
Q

What structures lie medial, anterior, and posterior to the 2nd part of duodenum?

A

Medial: Head of pancreas

Anterior: Gallbladder (fundus), Right lobe liver, and transverse colon

Posterior: Right kidney and ureter

35
Q

Which structures lie anterior and superior to the 3rd part of the duodenum?

A

Superior: Head of Pancreas

Anterior: Jejunum, SMV, SMA

*SMA syndrome: compression of third part of artery by the aorta posteriorly and SMA anteriorly

36
Q

What spinal level does the sigmoid colon start at and where does it go; type of peritoneal?

A
  • Starts at L5 and descends into the rectum at S3
  • Intraperitoneal
37
Q

What are Taenia coli; produce what upon contraction?

A
  • 3 bands of longitudinal muscle on the outsie of colon
  • Produce haustrae (sacculations)
38
Q

What are Omental (epiploic) appendices?

A

Tags of fat that are characteristic of the large intestine

39
Q

Where do you find the Appendix attached; supported by?

A
  • Posterior-medial part of the cecum

- Junction of 3 taenia coli

  • Supported by the mesoappendix
40
Q

The sigmoid colon is attahced to the wall by what?

A

Sigmoid mesocolon

41
Q

What are Diverticulosis; commonly found where?

A
  • Little pockets/pouches in the sigmoid colon
42
Q

What is Volvulus of Sigmoid colon?

A
  • Rotation and twisting of the sigmoid colon
  • Results in obstruction of the lumen proximal to the twisted segment
43
Q

What can Volvulus of the sigmoid colon lead to?

A

Constipation and ischemia of the looped part, may progress to fecal impaction and possible necrosis.

44
Q

What are the functional lobes of the left liver (roman numberals)?

A

Segment II: Left posterior lateral segment

Segment III: Left anterior lateral segment

Segment IV: Left medial segment

45
Q

What are the functional lobes of the right liver (roman numerals)?

A

Segment V: Right anterior medial segment

Segment VI: Right anterior lateral segment

Segment VII: Right posterior lateral segment

Segment VIII: Right posterior medial segment

46
Q

What is the Falciform ligament; contains which other ligament?

A

Ventral mesentery that connects the liver to the abdominal wall; contains the round ligament of the liver

47
Q

Bare area of the liver is defined by which ligament?

A

Anterior, posterior, and left/right coronary ligaments

48
Q

What is the Porta hepatis?

A
  • Transverse fissure between the caudate and quadrate lobes of liver, transmits the portal triad
49
Q

The ligamentum teres (round ligament of liver) is derived from what embryological structure?

A

Obliterated left umbilical vein

50
Q

The ligamentum venosum is derived from what embryologic structure?

A

Ductus venosus

51
Q

Where is the gallbladder found anatomically?

A
  • fossa for the gallbladder
  • Contacts anterior abdominal wall at 9th costal cartilage
52
Q

What are gallstones called and composed of?

A

Cholelithiasis (made of cholesterol crystals)

53
Q

What 3 places can gallstones get lodged?

A

1) Cystic duct
2) Hepatic duct
3) Hepatopancreatic ampulla

54
Q

Blockage of the cystic duct with gallstones may result in, and what are the presenting sx’s?

A
  • Cholecystitis
  • Biliary colic: intense spasmodic pain
  • Voluntary and involuntary guarding
  • Positive Murphy’s sign
55
Q

Where would the pain with blockage of the cystic duct w/ a gallstone be located?

A
  • Tip of right 9th rib
  • Referred pain to back and epigastric region
56
Q

What happens with blockage of the hepatopancreatic ampulla w/ a gall stone?

A
  • Bile duct and pancreatic duct both blocked
  • Bile may backup into pancreas and cause pancreatitis
  • Pt’s may also be jaundice
57
Q

If a gallstone enters the intestine, where else might a blockage be caused?

A

A gallstone in superior part of the duodenum will move through the digestive tract and cause a blockage at the ileocecal junction

58
Q

With a cholecysto-enteric fistula, which other organs may be affected?

A
  • Superior part of the duodenum
  • Transverse colon
59
Q

Describe the duodenum (1st, 2nd, 3rd, and 4th parts) using the vertebral levels and planes

A

1st - L1 (transpyloric plane)

2nd - L3 (subcostal plane

3rd - L3 (subcostal plane)

4th - L2 (directed superiorly to the left side)

60
Q

Describe the roots of the mesentry using the verterbal level and planes

A

Starts to the left of L2 and ends at transtubercular plane lateral to the right side of the linea semilunaris at L5

61
Q

What plane and vertebral level is the Ileocecal valve?

A

Transtubercular plane, lateral to linea semilunaris at L5

62
Q

Where is the upper border of liver in relation to planes and vertebral levels?

A

Xiphisternal plane (T9/10) to left linea semilunaris

63
Q

Where is the lower border of liver in relation to planes and vertebral levels?

A

Right costal margin to tip of right 9th costal cartilage to tip of left 8th costal cartilage to upper border

64
Q

Where is the gallbladder in relation to planes and vertebral levels?

A

Tip of 9th costal cartilage at the tranpyloric plane (L1)

65
Q

Where is the head, neck and body/tail of pancreas in relation to planes and vertebral levels?

A

Head - L2 in C of duodenum

Neck - Left side of L1

Body and Tail - Neck to hilum of spleen, lateral to left semilunaris

*GIGU I (67 decks)

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