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SMP - GI > Lecture 4 - Abdominal Viscera I > Flashcards

Lecture 4 - Abdominal Viscera I Flashcards

1
Q

2 parts of mouth in the digestive tract?

A
  1. Oral cavity

2. Pharynx

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2
Q

Esophagus region of abdomen?

A

Epigastric

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3
Q

How does the esophagus enter the abdomen? Vertebral level?

A

Through right crus of diaphragm at T10

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4
Q

Name of portion of stomach where esophagus enters? Location with regards to midline?

A

Cardial orifice of stomach, left of midline

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5
Q

Function of esophagus?

A

Connects pharynx to stomach

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6
Q

Vertebral levels of esophagus?

A

C6 to T11

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7
Q

Position of esophagus with regards to the midline?

A

Anterior aspect of vertebrae in midline => anterior and to the left laterally to be anterior to the thoracic aorta to enter the diaphragm

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8
Q

At what 4 locations can the esophagus be compressed/narrowed? What is at higher risk at these locations?

A
  1. Junction of esophagus and pharynx in the neck
  2. Aortic arch crossing over the esophagus in superior mediastinum
  3. Left main bronchus crossing over the esophagus in posterior mediastinum
  4. At esophageal hiatus in posterior mediastinum

Higher risk of swallowed objects getting lodged at these locations and if the object is corrosive it would cause more damage at these locations

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9
Q

Where do esophageal ruptures occur typically? Treatment?

A

Lower third of esophagus on the left

Treatment: urgent surgical repair

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10
Q

Only part of posterior mediastinum that lymphatically drains to abdomen?

A

Inferior 1/3rd of esophagus

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11
Q

What do we call the vagus nerves right before they become the anterior and posterior trunks on the esophagus?

A

Right and left vagal trunks

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12
Q

7 structures of the adult foregut?

A
  1. Esophagus (distal end)
  2. Stomach
  3. Duodenum (proximal half)
  4. Liver
  5. Gallbladder
  6. Pancreas
  7. Spleen
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13
Q

8 structures of the adult midgut?

A
  1. Duodenum (distal half)
  2. Jejunum
  3. Ileum
  4. Cecum
  5. Appendix
  6. Ascending colon
  7. Hepatic flexure of colon
  8. Transverse colon (proximal two-thirds)
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14
Q

5 structures of the adult hindgut?

A
  1. Distal third of the transverse colon
  2. Splenic flexure of colon
  3. Descending colon
  4. Sigmoid colon
  5. Rectum
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15
Q

Describe the surgical procedure of esophageal resection to treat cancer. What is this called?

A

Transthoracic esophagectomy:

  1. Patient is placed in supine position
  2. Laparotomy (surgical incision of abdomen) to assess evidence of disease in abdominal cavity
  3. Stomach is mobilized with preservation of right gastric and gastro-omental arteries
  4. Short gastric vessels and left gastric vessels are divided
  5. Pyloromyotomy is performed (incision in stomach on the pylorus, the furthest part of the stomach that connects to the duodenum)
  6. Abdominal wound is closed
  7. Patient is placed in left lateral position
  8. Right posterolateral thoracotomy is performed through 5TH INTERCOSTAL SPACE
  9. Azygos vein divided to provide full access to the whole length of the esophagus
  10. Stomach is delivered through the diaphragmatic hiatus
  11. Esophagus is resected and stomach is anastomosed to the cervical esophagus
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16
Q

How does esophageal cancer spread?

A

Submucosa or locoregional lymph nodes

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17
Q

When are most esophageal cancers diagnosed? Survival rate?

A

Late

Survival rate: 25% 5-year survival rate

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18
Q

What is the right side of the esophagus covered by?

A

Mediastinal pleura of right lung

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19
Q

Position of thoracic duct in regards to esophagus in posterior mediastinum?

A
  • Inferior portion: right side

- Superior portion: left side

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20
Q

4 structures that are posterior to the esophagus at some point in the posterior mediastinum?

A
  1. Thoracic duct
  2. Hemiazygos veins
  3. Right posterior intercostal arteries
  4. Thoracic aorta (near diaphragm)
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21
Q

5 structures that are anterior to the esophagus at some point in the posterior mediastinum?

A
  1. Trachea
  2. Right pulmonary artery
  3. Left main bronchus
  4. LA
  5. Aortic arch
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22
Q

What arteries do esophageal arteries arise from? Where does each originate from?

A

CERVICAL segment:
1. Inferior thyroid arteries from thyrocervical trunks which come from the subclavian arteries
THORACIC segment:
2. Thoracic aorta
3. Right bronchial arteries
4. Right posterior intercostal arteries from thoracic aorta
ABDOMINAL segment:
5. Left gastric artery from celiac trunk MAINLY
6. Short gastric artery from splenic artery
7. Left inferior phrenic artery from abdominal aorta

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23
Q

What veins do esophageal veins drain into?

A 
CERVICAL segment:
1. Inferior thyroid vein 
THORACIC segment:
2. Azygos vein
3. Hemiazygos vein
4. Accessory hemiazygos vein
ABDOMINAL segment: portal system through:
5. Left gastric vein 
6. Short gastric vein
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24
Q

Lymphatic drainage of esophagus? 9 types of nodes.

A
  1. Internal jugular lymph nodes
  2. Lower internal jugular lymph nodes
  3. Tracheal lymph nodes
  4. Tracheabroncheal lymph nodes
  5. Retrocardiac lymph nodes
  6. Infracardiac lymph nodes
  7. Posterior mediastinal lymph nodes
  8. Diaphragmatic lymph nodes
  9. Left gastric lymph nodes (inferior 1/3rd)
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25
Q

Innervation of esophagus?

A

Branches from vagus nerves and sympathetic trunks

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26
Q

Innervation of striated muscle in superior portion of the esophagus?

A

Branchial efferents from vagus nerves

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27
Q

Innervation of smooth muscle fibers in inferior portion of the esophagus?

A

Preganglionic fibers that are parasympathetic visceral efferents and synapse in the myenteric and submucosal plexuses of the enteric NS in the esophageal wall

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28
Q

Sensory innervation of esophagus? Which ones are responsible for transmitting pain information to the CNS?

A

Visceral afferents in :

  1. Vagus nerves
  2. Sympathetic trunks***
  3. Splanchnic nerves***
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29
Q

Are the visceral afferents from the vagus nerves involved in the relay of pain recognition?

A

NOPE

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30
Q

What are the 2 trunks formed by the esophageal plexus?

A

Trunks formed by the esophageal plexus just above the diaphragm:

  1. Anterior vagal trunk on anterior surface of esophagus mainly from fibers from left vagus nerve forming several smaller trunks
  2. Posterior vagal trunk on posterior surface of esophagus mainly from fibers from right vagus nerve forming a single trunk

These continue through the diaphragm

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31
Q

Are glands, liver, and pancreas embryological outgrowths of the digestive tract?

A

YUP

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32
Q

Describe the strength of the lower esophageal sphincter compared to the pyloric sphincter or sphincter of Oddi. Clinical significance?

A

WEAK, but the esophageal hiatus provides some additional strength

If the stomach is herniated through the esophageal hiatus, this extra support is lacking and the patient will experience GERD

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33
Q

What is the eaten apple sign?

A

Esophageal cancer on a CXR

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34
Q

What does the lining of the stomach form when it is empty?

A

Folds = rugae

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35
Q

Volume the stomach can hold?

A

~1/2 gallon

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36
Q

Effect of HCl on meat?

A

Softens connective tissue

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37
Q

What is the most dilated portion of the GIT?

A

Stomach

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38
Q

Regions of abdomen that stomach occupies?

A
  1. Epigastric
  2. Left hypochondrium
  3. Umbilical
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39
Q

4 regions of stomach? Describe each.

A
  1. The cardia, which surrounds the opening of the esophagus into the stomach
  2. The fundus of the stomach, which is the area above the level of the cardial orifice below the diaphragm
  3. The body of the stomach, which is the largest region of the stomach
  4. The pyloric part, which is divided into the pyloric antrum and pyloric canal and is the distal end of the stomach
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40
Q

What is the pyloric constriction?

A

External mark of pylorus on stomach

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41
Q

2 parts of pylorus?

A
  1. Pyloric sphincter

2. Pyloric orifice

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42
Q

Surface anatomy of pyloric orifice?

A

Just to the right of midline in transpyloric plane (L1)

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43
Q

What attaches to the greater curvature of stomach?

A

Point of attachment for the gastrosplenic ligament, the greater omentum, the gastrocolic ligament, and the gastrophrenic ligament

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44
Q

What attaches to the lesser curvature of stomach?

A

Point of attachment for the lesser omentum

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45
Q

What is the cardial notch of the stomach?

A

Superior angle created when the esophagus enters the stomach between esophagus and fundus of stomach

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46
Q

What is the angular incisure/notch of the stomach?

A

A bend on the lesser curvature where the body and pyloric antrum meet

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47
Q

What is the greater curvature of the stomach?

A

Longer, convex border

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48
Q

What is the lesser curvature of the stomach?

A

Shorter, concave border

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49
Q

Blood supply of stomach? Where does each arise from?

A
  1. Right gastric artery – variable in origin – usually branches off hepatic artery proper
  2. Left gastric artery – arises directly from celiac trunk
  3. Right gastroepiploic artery – 1 of 2 terminal branches of gastroduodenal artery
  4. Left gastroepiploic artery – arises from splenic artery
  5. Short gastric arteries (4-5) – arise from splenic artery (FUNDUS)
  6. Posterior gastric artery – arises from splenic artery BUT not always present
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50
Q

Other name for right/left gastroepiploic artery?

A

Right/left gastro-omental artery

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51
Q

Lymphatic drainage of stomach?

A

Celiac lymph nodes since follows arteries to stomach, which all branch directly or indirectly from the celiac trunk

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52
Q

3 structures located anterior to the stomach?

A
  1. Left liver lobe
  2. Anterior body wall
  3. Diaphragm
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53
Q

2 structures located posterior to the stomach?

A
  1. Pancreas

2. Spleen

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54
Q

Arteries along lesser curvature of stomach?

A

Right and left gastric arteries

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55
Q

Arteries along greater curvature of stomach?

A

Right and left gastro-omental arteries

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56
Q

What is a trichobezoar?

A

Hair stuck in the stomach

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57
Q

Changes in diameter of small intestine throughout its course?

A

Narrowing

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58
Q

Beginning and end of duodenum?

A
  1. Beginning: pylorus

2. End: duodenojejunal junction

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59
Q

Vertebral levels of duodenum? What does this correspond to?

A

L1 to L3

L1 is halfway between jugular notch and pubic area

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60
Q

4 parts of duodenum? Describe each along with their vertebral level. Which one is the longest?

A
  1. The superior part (L1): extends from the pyloric orifice of the stomach to the neck of the gallbladder, is just to the right of the body of vertebra L1, mostly horizontal
  2. The descending part (L2/L3): curves around head of pancreas, just to the right of midline and extends from the neck of the gallbladder to the lower border of vertebra L3
  3. The inferior part (L3)=horizontal part: longest section, crossing the IVC, the aorta, and the vertebral column
  4. The ascending part (L2/L3): upward on, or to the left of, the aorta to approximately the upper border of vertebra L2 and terminates at the duodenojejunal flexure
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61
Q

Overall shape of duodenum?

A

C shaped

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62
Q

Where do most duodenal ulcers occur?

A

Superior first part of it

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63
Q

2 other names for superior part of duodenum?

A

The ampulla or duodenal cap

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64
Q

5 structures posterior to duodenum?

A
  1. Bile duct
  2. Gastroduodenal artery
  3. Portal vein
  4. IVC
  5. Right kidney
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65
Q

What is the major duodenal papilla?

A

Common entrance for the bile and pancreatic ducts in the descending part of the duodenum

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66
Q

What passes the anterior surface of the descending part of the duodenum?

A

Transverse colon

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67
Q

What is the minor duodenal papilla? Where is it located with regards to the major duodenal papilla?

A

Entrance for the accessory pancreatic duct

Just above the major duodenal papilla

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68
Q

Location of right kidney with regards to duodenum?

A

Posterior to descending part of duodenum

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69
Q

What 2 structures pass anteriorly to the horizontal part of the duodenum?

A
  1. Superior mesenteric artery

2. Superior mesenteric vein.

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70
Q

Other name for horizontal part of duodenum?

A

Inferior part

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71
Q

What supports the duodenojejunal junction? Clinical significance?

A

Ligament of Treitz

A surgeon can feel for this ligament in order to identify the junction

72
Q

Other name for ligament of Treitz?

A

Suspensory muscle of the duodenum

73
Q

Blood supply to duodenum? Where does each arise from? What part of the duodenum does each supply?

A
  1. Branches from the gastroduodenal artery
    SUPERIOR DUODENUM:
  2. Supraduodenal artery from the gastroduodenal artery
    DESCENDING DUODENUM:
  3. Duodenal branches from the anterior superior pancreaticoduodenal artery (from the gastroduodenal artery)
  4. Duodenal branches from the posterior superior pancreaticoduodenal artery (from the gastroduodenal artery)
    INFERIOR DUODENUM:
  5. Duodenal branches from the anterior inferior pancreaticoduodenal artery (from the inferior pancreaticoduodenal artery from the SMA)
  6. Duodenal branches from the posterior inferior pancreaticoduodenal artery (from the inferior pancreaticoduodenal artery from the SMA)
    ASCENDING DUODENUM:
  7. 1st jejunal branch from the SMA
74
Q

What portion of the jejunum+ileum does the jejunum represent?

A

Proximal 2/5ths

75
Q

Regions of abdomen that jejunum occupies?

A

LUQ / umbilical region

76
Q

Average length of small intestine? Length required for survival?

A

10-30 feet

Can survive with as little as 2 feet

77
Q

Which has a thicker wall: jejunum or ileum?

A

Jejunum

78
Q

Unique characteristics of jejunum compared to ileum?

A
  1. LESS prominent arterial arcades
  2. Longer vasa recta (straight arteries)
  3. More and more prominent plicae circulares
  4. Less mesenteric fat
  5. Less lymphatics and no Peyer’s patches
  6. Thicker walls
79
Q

What are plicae circulares?

A

Numerous prominent folds circling the lumen of the inner mucosal lining beginning towards the end of the duodenum and are most prominent in the jejunum; they disappear about half way through the ileum

80
Q

Blood supply to jejunum? Where does each arise from?

A

Jejunal arteries from the left SIDE of the SMA

81
Q

Quadrant of ileum?

A

RLQ

82
Q

What is the ileocecal fold? Function?

A

Two flaps projecting into the lumen of the large intestine surround the opening from ileum to cecum and come together at their end, forming ridges with musculature from the ileum continuing into each flap, forming a sphincter

Possible functions of the ileocecal fold include preventing reflux from the cecum to the ileum, and regulating the passage of contents from the ileum to the cecum

83
Q

Blood supply to ileum? Where does each arise from?

A
  1. Ileal arteries from the left side of SMA

2. An branch from the ileocolic artery from the right side of the SMA

84
Q

What are the lymphatic organs of the ileum called?

A

Peyer’s patches

85
Q

What 3 structures increase surface area of small intestine? by how much?

A
  1. Villi
  2. Microlli
    By 6-100 fold
  3. Plicae circulares
    1.6-2 fold
86
Q

What is an ileal conduit?

A

Extraanatomical procedure performed after resection of the bladder for tumor:

  1. A short segment of ileum is identified
  2. The bowel is divided twice to produce a 20-cm segment of small bowel on its own mesentery: isolated segment of bowel used as a conduit (proximal end is anastomosed to the ureters, and the distal end is anastomosed to the anterior abdominal wall) and remaining bowel is joined together
  3. Urine passes from the kidneys into the ureters and through the short segment of small bowel to the anterior abdominal wall
  4. Collecting bag is fixed to the anterior abdominal wall
87
Q

What connects the ileum and jejunum to the posterior abdominal wall?

A

6 inch fan-shaped mesentery from left side of L2 to right iliac fossa = mesentery of small intestine

88
Q

Does the large intestine secrete enzymes?

A

NOPE

89
Q

Effect of bacteria of large intestine working on feces? Effect of systemic antibiotics?

A

Production of vitamin K and B-complex vitamins

Antibiotics could destroy these symbiotic bacteria

90
Q

2 flexures of the large intestine? 2 names for each

A
  1. Hepatic = right colic

2. Splenic = left colic

91
Q

What are omental appendices?

A

Omental sacs containing fat located on teniae coli of the colon

92
Q

Length of large intestine?

A

5 feet

93
Q

4 parts of large intestine?

A
  1. Cecum
  2. Appendix
  3. Colon
  4. Rectum
94
Q

Regions of abdomen that ascending colon occupies?

A

Right flank and right hypochondrium

95
Q

Regions of abdomen that cecum and appendix occupy?

A

Right groin

96
Q

What is located superiorly to right colic flexure?

A

Liver right lobe

97
Q

Regions of abdomen that transverse colon occupies?

A

Right to left hypochondrium

98
Q

What is located superiorly to left colic flexure?

A

Spleen

99
Q

Regions of abdomen that descending colon occupies?

A

Left hypochondrium to left groin

100
Q

Where are the taeniae coli most visible in the large intestine? Where are they less visible?

A

Primarily observed in the cecum and colon and less visible in the rectum

101
Q

What part of large intestine enters pelvis?

A

Sigmoid colon

102
Q

Position of cecum?

A

Inferior to the ileocecal opening and in the right iliac fossa

103
Q

Can the cecum be in the pelvis?

A

Yes, sometimes

104
Q

Where is the appendix located on cecum?

A

Attached to the posteromedial wall of the cecum, just inferior to the end of the ileum

105
Q

What does the appendix contain?

A

Large aggregations of lymphoid tissue in its walls

106
Q

How is the appendix suspended from the terminal ileum? What does this structure contain?

A

By the mesoappendix, which contains the appendicular vessels

107
Q

Blood supply to cecum + appendix? Where does each arise from?

A
  1. Anterior cecal artery from the ileocolic artery (from the SMA)
  2. Posterior cecal artery from the ileocolic artery (from the SMA)
  3. Appendicular artery from the ileocolic artery (from the SMA) (only one going to appendix)
108
Q

Location of left colic flexure with regards to right one?

A

Higher and more posterior than the right colic flexure

109
Q

What is the right colic flexure attached to?

A

Attached to the diaphragm by the phrenicocolic ligament

110
Q

Blood supply to ascending colon? Where does each arise from?

A

ALL FROM SMA:

  1. Colic branch from the ileocolic artery
  2. Anterior cecal artery from the ileocolic artery
  3. Posterior cecal artery from the ileocolic artery
  4. Right colic artery
111
Q

What are the paracolic gutters? Where are they located? Clinical significance?

A

Immediately lateral to the ascending and descending colon are the right and left paracolic gutters = depressions formed between the lateral margins of the ascending and descending colon and the posterolateral abdominal wall and are gutters through which material can pass from one region of the peritoneal cavity to another

Because major vessels and lymphatics are on the medial or posteromedial sides of the ascending and descending colon, a relatively blood-free mobilization of the ascending and descending colon is possible by cutting the peritoneum along these lateral paracolic gutters

112
Q

Lowest vertebral level of sigmoid colon?

A

S3

113
Q

Shape of sigmoid colon?

A

S shaped

114
Q

Attachments of sigmoid colon? What about in between?

A
  1. Its beginning, where it continues from the descending colon
  2. Its end, where it continues as the rectum

Between these points, it is suspended by the sigmoid mesocolon to the posterior abdominal and pelvic walls

115
Q

Blood supply to transverse colon? Where does each arise from?

A
  1. Right colic artery from the SMA
  2. Middle colic artery from the SMA
  3. Left colic artery from the IMA
116
Q

Blood supply to descending colon? Where does each arise from?

A

Left colic artery from IMA

117
Q

Blood supply to sigmoid colon? Where does each arise from?

A

Sigmoid arteries from IMA

118
Q

Location of root of appendix? Location of rest of appendix?

A

Where 3 taeniae coli meet at posteromedial aspect of cecum, inferior to the ileocecal junction

Rest: appendix can lie anywhere the hands of a
clock can lie

119
Q

Vertebral levels of rectum?

A

S3 to coccyx

120
Q

Blood supply to rectum + anal canal? Where does each arise from?

A
  1. Superior rectal artery from the IMA
  2. Middle rectal artery: from inferior vesical artery in men and uterine artery in women, both from the internal iliac artery
  3. Inferior rectal arteries from the internal pudendal arteries (from the internal iliac artery)
121
Q

Is the rectum fixed?

A

YUP

122
Q

Length of rectum?

A

5 inches

123
Q

2 other names for ascending colon?

A

Right colon = absorbing colon

124
Q

2 other names for descending colon?

A

Left colon = storage colon

125
Q

Consistency of feces in ascending colon?

A

Fluid

126
Q

Consistency of feces in transverse colon?

A

Mush

127
Q

Consistency of feces in descending colon?

A

Semi-solid

128
Q

What can be palpated during a digital rectal exam?

A

MALES:

  1. Prostate
  2. Seminal vesicles

FEMALES

  1. Cervix
  2. Posterior fornix
  3. Maybe ovaries
  4. Uterus cancer
  5. Foreign objects in vagina

BOTH: potential distal colorectal tumors or polyps

129
Q

What is BPH?

A

Benign prostatic hyperplasia

130
Q

Blood supply of foregut? Vertebral level?

A

Celiac trunk: L1

131
Q

Blood supply of midgut? Vertebral level?

A

SMA: L1

132
Q

Blood supply of hindgut? Vertebral level?

A

IMA: L3

133
Q

4 unpaired branches of the abdominal aorta? Location?

A

Located in the midline:

  1. Celiac trunk
  2. SMA
  3. IMA
  4. Median sacral artery
134
Q

3 branches of the celiac trunk? Location for each?

A
  1. Left gastric artery: descends on superior portion of the lesser curvature of stomach to anastomose with right gastric artery at the cardioesophageal junction
  2. Splenic artery: along posterior surface of stomach and superior border of pancreas to spleen
  3. Common hepatic artery: very short branching to the right of the celiac trunk
135
Q

Branches of left gastric artery?

A

Esophageal branches

136
Q

4 branches of splenic artery? Location for each? List in branching order.

A
  1. Dorsal pancreatic artery: proximal body of posterior pancreas
  2. Greater pancreatic artery: distal body of posterior pancreas
    SAME BRANCHING POINT:
  3. Short gastric arteries: on surface of fundus of stomach
  4. Left gastroepiploic artery: along greater curvature of stomach to anastomose with right gastroepiploic artery
137
Q

3 branches of common hepatic artery? Location for each? List in branching order.

A
  1. Gastroduodenal artery: posterior to superior duodenum

2. Hepatic artery proper: extending to the right and superiorly directed to liver

138
Q

3 branches of gastroduodenal artery? Location for each? List in branching order.

A
  1. Supraduodenal artery to superior duodenum
  2. Anterior and posterior superior pancreaticoduodenal arteries on each side of the head of the pancreas
  3. Right gastroepoploic artery: along greater curvature of stomach to anastomose with left gastroepiploic artery
139
Q

Branches of hepatic artery proper? Location?

A

Left and right hepatic arteries

140
Q

Branches of the SMA? Location for each? List in branching order.

A

LEFT SIDE:

  1. Jejunal arteries
  2. Ileal arteries

RIGHT SIDE:

  1. Inferior pancreaticoduodenal artery
  2. Middle colic artery to transverse colon
  3. Right colic artery to ascending colon
  4. Ileocolic artery to cecum
141
Q

Branches of ileocolic artery?

A
  1. Anterior cecal artery
  2. Posterior cecal artery
  3. Appendicular artery
  4. Ileal branch
142
Q

Branches of the IMA? Location for each? List in branching order.

A
  1. Left colic artery to descending colon
  2. Sigmoid arteries to sigmoid colon
  3. Superior rectal artery to rectum
143
Q

Venous drainage of GIT?

A

Veins named after arteries and all drain into the portal vein => liver => IVC

144
Q

What is intestinal lymph called? Why is it special?

A

Chyle

Special because it transports fat

145
Q

Lymph pathway of GIT?

A

Right and left lumbar trunks + pre-aortic nodes form the intestinal trunk => cisternal chyli => thoracic duct => enters thorax posterior to aorta through aortic hiatus => posterior mediastinum to the right of midline between thoracic aorta and azygos vein and posterior to esophagus and anterior to vertebrae => moves to left of midline at T5 and enters superior mediastinum => through superior mediastinum to neck => left jugular trunk and left subclavian trunk (draining left neck/head and left upper limb) join the thoracic duct => empties into junction of left subclavian and left internal jugular veins

146
Q

Vertebral level of cisternal chyli?

A

L1

147
Q

Referred pain area of foregut? Nerve?

A

Epigastric region

Visceral afferents in greater splanchnic

148
Q

Referred pain area of midgut? Nerve?

A

Umbilical region

Visceral afferents in lesser splanchnic

149
Q

Referred pain area of hindgut? Nerve?

A

Pubic region

Visceral afferents in lumbar splanchnic

150
Q

Pain due to appendicitis? Test to diagnose?

A

Begins as central diffuse periumbilical (T10) colicky REFERRED pain from appendix that comes and goes => with time pain becomes DIRECT and constant from parietal peritoneum and localizes to the right iliac fossa in LRQ in the right groin (can occur even in the absence of ruptures of the appendix) and patient will guard themselves from touch => peritoneal infection moves to the undersurface of the diaphragm => pain sensation from an inflamed diaphragm is sent back to the CNS via the phrenic nerve, C3, C4, and C5 - cutaneous pain sensation from the right shoulder region also travels to the CNS via C3, C4, and C5 (supraclavicular nerves) so the brain is unable to distinguish the cause of the pain)

Test: rebound pain test

151
Q

Cause of appendicitis? Complications?

A

Appendix is obstructed by fecalith or enlarged lymphoid nodules => bacteria invade the walls => damage due to pressure necrosis => can lead to perforation which can lead to generalized peritonitis

152
Q

What is Meckel’s diverticulum? What does it appear as? Typical symptoms?

A

Failure of the vitelline duct to fully regress results in Meckel’s diverticulum = remnant of the proximal part of the yolk stalk (vitelline duct) that extends into the umbilical cord in the embryo and lies on the antimesenteric border of the ileum

It appears as a blind-ended tubular outgrowth of bowel.

Typical findings include hemorrhage, intussusception, diverticulitis, ulceration, and obstruction

153
Q

What is the rule of 2s for Meckel’s diverticulum?

A
  • Uncommon finding (occurring in approximately 2% of the population)
  • 2 times more common in males
  • Usually 2 inches long
  • 2 feet proximal from the ileocecal junction
  • Contains one of 2 ectopic tissues: gastric or pancreatic
  • Most commonly diagnosed in first 2 years of life
154
Q

Lymph drainage of ileum?

A

Superior mesenteric lymph nodes

155
Q

Innervation of ileum?

A

Superior mesenteric plexus

156
Q

Lymph drainage of cecum?

A
  1. Mesenteric lymph nodes

2. Superior mesenteric lymph nodes

157
Q

Innervation of cecum?

A

Superior mesenteric plexus

158
Q

Lymph drainage of ascending colon?

A
  1. Colic lymph nodes

2. Superior mesenteric lymph nodes

159
Q

Innervation of ascending colon?

A

Superior mesenteric plexus

160
Q

Lymph drainage of transverse colon?

A
  1. Colic lymph nodes
  2. Superior mesenteric lymph nodes
  3. Inferior mesenteric lymph nodes
161
Q

Innervation of transverse colon?

A

Superior and inferior mesenteric plexuses

162
Q

Innervation of descending colon?

A

Inferior mesenteric plexus

163
Q

Lymph drainage of descending colon?

A
  1. Colic lymph nodes

2. Inferior mesenteric lymph nodes

164
Q

Lymph drainage of sigmoid colon?

A
  1. Colic lymph nodes

2. Inferior mesenteric lymph nodes

165
Q

Innervation of sigmoid colon?

A

Inferior hypogastric plexus

166
Q

Location of superior mesenteric artery and vein in regards to stomach?

A

Posterior to the pyloric antrum

167
Q

Is the anal canal part of the large intestine?

A

NOPE, it’s a continuation of it

168
Q

Where is the junction between foregut and midgut located?

A

Inferior to major duodenal papilla

169
Q

What passes the anterior surface of the superior part of the duodenum?

A

Left liver lobe

170
Q

Which arteries supply the antrum of the stomach?

A

Branches from right gastric and right gastroepiploic arteries

171
Q

Which arteries supply the body of the stomach?

A

Branches from right gastric and right and left gastroepiploic arteries

172
Q

% of appendicites that rupture?

A

10-15% of cases

173
Q

What are intestinal arterial arcades?

A

Anastomoses between intestinal vasa rectae

174
Q

Length from duodenojejunal junction to ileocecal junction if you connect the dots diagonally?

A

15 cm

175
Q

Length of ileum and jejunum combined?

A

6 meters

176
Q

What 3 structures can be felt during a rectum exam in both men and women?

A
  1. Coccyx
  2. Sacrum
  3. Ischial spines
177
Q

Cystic artery branching?

A

From right hepatic artery

SMP - GI (21 decks)

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