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Gastroenterology I > Organs > Flashcards

Organs Flashcards

1
Q

LES is located approximately where the esophagus enters the stomach at the level of T11… How do you find this plane?

A

T11 doesn’t have a name, but you find the midpoint between the Linea alba and the Linea semilunaris and trace it up to the costal margin. then draw a transverse plane and that’s t11.

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2
Q

How do you find T9?

A

find the Linea alba and trace up to the sternum

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3
Q

ASIS bilaterally and between them is what?

A

Interspinous Plane = S2

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4
Q

L1 is found where?

A

find the semilunaris and draw upwards to the costal margin. once you hit the ribs that’s L1

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5
Q

Where does the Esophagus enter the stomach?

Stomach?

Pylorus

A

through the diaphragmatic hiatus at T10-T11

T11

L1

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6
Q

What does the phrenicoesophageal ligament do?

A

allow independent motion of the esophagus and the diaphragm.

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7
Q

What are the 3 constriction points of the esophagus?

A

Cervical: UES + Cricopharyngeus muscle

Thoracic: (2 part constriction) –> esophagus is in contact with the aorta and left main bronchus

Diaphragmatic: As it passes through the esophageal hiatus at t10. (implicated in hiatal hernias)

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8
Q

What is a hiatal hernia? what are the two types?

A

abdominal structures going into the thorax

Paraesophageal: Fundus protrudes adjacent to the esophagus into the thorax (usually on the left because of the liver.

Sliding: most common. Hourglass shape. GEJ is displaced superiorly so the LES is affected. It’s the cardia that’s protruding, not the fundus.

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9
Q

Why does someone with paraesophageal hernias not present with any symptoms?

A

because the GEJ is normal and they don’t have any reflux

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10
Q

what is the angular incisure?

A

wehre the body of the stomach meets the pyloric portion.

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11
Q

Why is the stomach a dynamic structure?

A

stomach can descend as low as the pelvis.

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12
Q

What is the gastrohepatic ligament? Gastrocolic ligament?

A

connects liver with the stomach (at lesser curvature)

connects greater curvature to the colon

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13
Q

What is a duodenal ulcer?

A

most like to occur at the posterior wall of the 1st part of the duodenum.

can cause a lot of hemorrhage.

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14
Q

Vagotomy? 3 types?

A

surgical treatment of GERD.

Vagotomy can help prevent acid for being secreted.

Truncal - stomach and other parts of the GI

Selective gastric = only the stomach

Selective Proximal = knock out the stuff around the ulcer only

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15
Q

How do you locate L3?

A

midaxillary line and look at the inferior costal margin.

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16
Q

Where are the planes of the duodenum?

A

1st part = L1
2nd part = L2-L3 on the right
3rd part = anterior to L3
4th part = left of L3 vertebra - superior to about L2.

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17
Q

What’s the difference between the first part of the duodenum from the rest of it?

A

first part of the first part is intraperitoneal, the rest is retroperitoneal!

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18
Q

What’s so important about the hepatoduodenal ligament?

A

houses proper hepatic artery, portal vein, and bile duct.

marks the entrance to the lesser sac behind the stomach.

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19
Q

What’s behind the first part of the duodenum?

A

gastroduodenal artery. if ulcers perforate this you have a life threatening injury

20
Q

What’s in the descending portion of the duodenum?

A

Major Duodenal papilla –>

the common bile duct empties bile as well as the pancreatic duct puts in pancreatic ducts.

21
Q

What happens if you have a obstruction above the major duodenal papilla?

A

vomit = will not see bile

22
Q

What’s posterior to the horizontal portion of the duodenum?

A

inferior vena cava (posterior)

superior mesenteric a/v (anterior)

23
Q

What does the suspensory muscle do?

A

also called the ligament of Treitz. Last segment of the duodenum

connects right crus of the diaphragm to the last portion of the duodenum –> pooping bright red blood or charcoal depending on if its proximal or distal to this.

24
Q

How is the jejunum and ileum attached to the posterior wall?

A

via mesentary

25
Q

Difference between the following for jejunum and ileum:

vasa recta
arcades

Fat in mesentary

Circular folds

Lymphoid Nodules

A

long, short

few long loops, many short loops

Less, More

Large tall closely packed, low and sparse

few, many

26
Q

What is Meckel Diverticulum?

Rule of 2’s?

lead point for what?

A

you have ectopic gastric / pancreatic tissue producing acid, you can erode and cause the bleeding seen in a patient.

2x more likely in males
2 inches long
2 feet from ileocecal valve
2% of population
common in first 2 years of life
2 types of epithelia

most common lead point to intussusception

27
Q

What is Intussusception?

where is it common?

what will you see on ultrasound?

A

proximal bowel segment is teloscoping the distal segment

common at ileocecal junction.

ultrasound = Target sign

28
Q

Where is the ileocecal junction located?

What about the lower edge of the ascending colon?

A

L5. Widest portion on the hips and draw a transverse line.

S2 (interspinous)

29
Q

What parts of the large intestine are retroperitoneal?

A

descending and ascending colon

30
Q

What is the longitudinal band of muscle on the large intestine? what’s on each side of it?

A

Tenieae Coli

Omental Appendices or Epicloic appendices

31
Q

Where do you find the appendix?

A

1/3 of the way between right ASIS and umbilicus (McBurney’s point)

32
Q

Where do the teniae coli terminate?

A

sigmoid colon

33
Q

What is volvulus?

A

common at sigmoid colon for elderly. midgut for kids

“coffee bean” sign on X-ray

intestine rotates on itself leading to necrosis

34
Q

Where is the top of the liver located at in most individuals?

A

xiphisternal plane (T9)

35
Q

How do you do a liver biopsy?

A

find rib 10, go superiorly and have them exhale and hold it so it goes up and you don’t collapse a lung. then you do the biopsy.

36
Q

For anatomic lobes of the liver, how are the right and left lobes separated?

what are the two extra lobes?

A

falciform ligament, which connects the liver to the anterior abdominal wall.

Quadrate (part of left hemi-liver) + Caudate (functionally separate)

37
Q

What are the different ligaments of the liver?

A

Falciform ligament

Round ligament (remnant of the umbilical vein)

Ligamentum Venosum (ex ductus venosus -> accept oxygen rich blood from the liver and shunt it)

hepatoduodenal ligament (has those 3 structures –> hepatic artery, bile duct, portal vein..

38
Q

Pringle maneuver?

A

if someone is bleeding and you don’t know why, if you do this maneuver and it stops, you know it’s coming from the proper hepatic artery and vein.

39
Q

Why if you remove a portion of the functional liver it doesn’t affect the whole organ?

A

each one has it’s own portion of the hepatic artery, vein, bile duct.

40
Q

Why is the caudate called the 3rd liver?

A

receives vessels from both portal bundles.

41
Q

What separates the right and left FUNCTIONAL lobes?

what #’s are associated with right liver? left liver?

A

imaginary Cantlie line. (tip of gallbladder to the diaphragm)

5,6,7,8
1,2,3,4

42
Q

what segments are the gallbladder found near on the liver?

A

4+5

43
Q

Pathway of bile?

A

Gallbladder –> cystic duct –> common bile duct –> meet with pancreatic duct and dump into the ampulla of vater (hepatopancreatic ampulla) in the 2nd part of the duodenum

44
Q

what’s the deal with obstructions and the gallbladder?

A

whatever’s above it will have the infection

45
Q

Cholelithiasis? 4 f’s?

what’s the sign to do for this?

what is choledocolithiasis?

A

gallstone.

murphy’s sign

Female, Forty, Fertile, Fat

obstruction of the common bile duct

46
Q

What is gallstone ileus?

A

gallstone can inflame the gallbladder and cause adhesions, perforate, travel to ileocecal junction, and obstruct it because it’s the narrowest point of the Small intestine.

47
Q

Where is the spleen located?

what’s good to know about it?

what are the two ligaments? why are they important?

A

9th-11 ribs are posterior to it.

it’s vulnerable to blunt trauma

splenorenal ligament –> houses splenic artery

gastrosplenic ligament –> houses short gastric arteries (he’s doing this for his research project)

Gastroenterology I (5 decks)

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