Organs

Question 1

Esophagus

Answer 1

25 cm long

Passes thru right crus of the diaphragm at T10, Enters cardial orifice of the stomach at T11

Attached to diaphragm via phrenico-esophageal ligament

Question 2

Esophageal Constrictions

Answer 2

Cervical: Upper sphincter, Cricopharyngeus muscle

Thoracic: Esophagus in contact with aorta and left main bronchus

Diaphragmatic: As is passes thru the esophageal hiatus at T10. Implicated in hiatal hernias

Question 3

Hiatal Hernias

Answer 3

Abdominal structures enter the thorax commmonly left sided

Paraesophageal: Normal GEJ, fundus protrudes into throax, less chance of GERD

Sliding: Most common, GEJ displaced superiorly, Cardia protrudes, Hourglass stomach

Question 4

Ligaments of Stomach

Answer 4

Gastrohepatic: Ligament connecting lesser curvature to liver. gastric vessels

Gastrocolic: Ligament connecting greater curvature to transverse colon. Part of greater omentum. Gastroepiploic vessels.

Question 5

Gastric Ulcer

Answer 5

Stomach
70% related to H. Pylori

Complications: Lesser curvature ulcer can cause hemorrhage from left gastric a.

Question 6

Duodenal Ulcer (Peptic Ulcer)

Answer 6

Pylorus or Duodenum

90% related to H. Pylori

65% occurs in the posterior wall of the 1st part of the duodenum

Complications: Hemorrhage from gastroduodenal a. for posterior ulcers in 1st part of duodenum. Ulcer in 1st part of duodenum can cause adhesion with Gb and Liver. Anterior ulcer can perforate into peritoneal space. Pancreas may be affected

Question 7

Vagotomy

Answer 7

Surgical Tx for GERD

Parts of vagus nerve are removed to decrease rate of gastric secretions

Truncal vs selective gastric vs selective proximal vagaotomy

Question 8

Ligament of Treitz

Answer 8

Suspensory muscle of the duodenum. Located at juction between the duodenum and the jejunum, marking their division. (duodenojejunal flexture)

Flexing to this muscle widens the angle of the duodenum/jejunum and allows for movement of chyme

Question 9

Jejunum

Answer 9

Deep red color 
Walls are thick and heavy 
Highly vascular 
Vasa recta are long 
arcades: few, large loops 
Less fat in mesentery than ileum 
Circular folds are tall, large, and closely packed 
Few LN

Question 10

Ileum

Answer 10

Pale pink color 
Walls are thin and light 
Less vasculature than jejunum 
Short vasa recta 
Arcades: many short loops 
more fat in mesentery than jejunum
Circular folds are low and sparse, absent in the distal part 
Many LN

Question 11

Meckel Diverticulum

Answer 11

Most common congenital anomaly of GI tract
True diverticulum
Persistent vitelline/omphalomesenteric duct
Can contain ectopic gastric or pancreatic tissue

Rule of 2s: 
2 times more likely in males 
2 inches long 
2% of population 
Common in the fist 2 yrs of life if symptomatic 
2 types of epithelial may be present 

Most common pathologic lead point for intussusception

Question 12

Intussusception

Answer 12

Telescoping of proximal bowl segemtn into distal segment

Common at ileocecal jxn

“target sign” on US

Mostly children

Idiopathic vs meckel (kids) vs tumor (adults)

Question 13

Sigmoid Colon

Answer 13

From iliac fossa to S3

Teniae coli terminate at the rectosigmoid junction

Has a long mesentery: sigmoid mesocolon

Most common site of volvulus in the elderly

Question 14

Volvulus

Answer 14

Rotation of loop of bowel

Can cause constipation, ischemia, and necrosis

Midgut volvulus more common in infants

sigmoid volvulus are more common in elderly

Coffee bean sign on XR

Question 15

Liver

Answer 15

largest ab organ

Occupies most of RUQ and can extend as far as left anterior axillary line

Follows subcostal line

Will move inferiorly on inspiration which will aid palpation

Question 16

Ligaments of Liver

Answer 16

Falciform ligament connects liver to anterior wall

Round ligament (teres): remnant of umbilical vein

Ligamentum venosum (ex ductus venosus)

Hepatoduodenal ligament: Contains the proper hepatic artery, bile duct and the portal vein. Anterior boundary of epiploic foramen

Question 17

Liver: Functional Lobes

Answer 17

Separated into right and left based on primary division of portal triad; except caudate lobe which receives vessels from both portal bundles

Cantlie line is imagined from the fundus of gallbladder superiorly to the diaphragm (Note: left medial division is part of right functional lobe)

Important for hepatic segmentectomies

Question 18

Gallbladder

Answer 18

Blind diverticulum located between IV adn V segments of liver

Has fundus, body, and neck

Attached to common bile duct via cystic duct

Common bile duct meets with pancreatic duct to empty into ampulla of vater in the 2nd part of duodenum

Question 19

Cholelithiasis

Answer 19

50% are asymptomatic

Gallstones obstructing the cystic duct can cause cholecystitis (Female, Forty, Fertile, Fat)

Murphy’s sign for cholecystits: Palpate RUQ and ask patient to inhale. Sudden halt to inspiration d/t pain is a + sign

Choledocolithiasis is caused by an obstruction of the common bile duct

Gallstone ileus is the obstruction of the ileocecal junction from a gallstone

Question 20

Spleen

Answer 20

Largest Lymph Organ
Vulnerable to blunt trauma
LUQ

Ligaments: splenorenal ligament, splenic artery. gastrosplenic ligament, short gastic arteries.