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GI Exam 1 > Organs of the GI Tract > Flashcards

Organs of the GI Tract Flashcards

1
Q
  • What are the main organs of the GI Tract?
A
  • Esophagus
  • Stomach
  • SI
    • Duodenum
    • Ileum
    • Jejunum
  • Large Intestine
    • Cecum
    • Ascending colon
    • Transverse Colon
    • Descending Colon
    • Sigmoid Colon
    • Rectum
  • Liver
  • Gallbladder
  • Pancreas
    Spleen
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2
Q

What level are the following anatomical structures located:

  • Esophagus
  • Stomach
  • Pylorus
A
  • Esophagus: T10-T11
  • Stomach: T11
  • Pylorus: L1
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3
Q
  • Esophagus
    • Passes thru _ of the diaprhagm at what spinal level?
    • Enters _ of the stomach at what spinal level?
    • Attached to diaphragm via _ ligament
A
  • Right crus of diaphragm at T10
  • Enters cardiac orifice of stomach at T11
  • Phrenicoesophageal ligament
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4
Q
  • What are the three esophageal constrictions?
A
  • Cervical
    • Pharyngo-esophageal junction controlled by cricopharyngeus muscle
  • Thoracic (2 Part)
    • Esophagus in contact with aorta and left main bronchus
  • Diaphragmatic
    • As it passes through the esophageal hiatus at T10
    • Implicated in hiatal hernias
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5
Q
  • Para-esophageal hernias
A
  • Usually asymptomatic
  • Normal GEJ
  • Fundus protrudes into thorax
  • Less chance of GERD
  • Left side more common (liver is in the way on the right side)
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6
Q
  • Sliding hiatal hernia
A
  • Most common
  • GEJ displaced superiorly
  • *Cardia portrudes into thorax**
  • Hourglass stomach
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7
Q
  • Identify the parts of the stomach
A
  1. Esophagus
  2. Cardia
  3. Angular incisure
  4. Pylorus
  5. Duodenum
  6. Pyloric antrum
  7. Lesser curvature
  8. Greater Curvature
  9. Body
  10. Fundus
  11. Cardial Notch
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8
Q
  • The stomach is a _ structure
A
  • Dynamic/intraperitoneal structure
  • Not fixed:
    • Obese people have higher displaced stomach compared to very thin people
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9
Q
  • Anteriorly, the stomach relates with _
A
  • Diaphragm
  • Left lobe of liver
  • Anterior abdominal wall
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10
Q
  • Inferolaterally, the stomach relates with _
A
  • Transverse colon
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11
Q
  • Posteriorly, the stomach relates with _
A
  • Diaphragm
  • Spleen
  • Left upper kidney and syprarenal gland
  • Pancreas
  • Omental bursa (lesser sac)-stomach forms most of its anterior wall
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12
Q
  • Important ligaments of the stomach
A
  • Gastrohepatic
    • ​Connects lessure curvature of stomach to the liver
    • *Contains gastric vessels*
  • Gastrocolic
    • ​Connects greater curvature to transverse colon
    • *Contains gastroepiploic vessels and part of the greater omentum*
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13
Q
  • Label the following
A
  1. Pylorus
  2. Transpyloric plane
  3. Transtubercular plane
  4. Cardial Orifice of Stomach
  5. Pyloric Antrum
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14
Q
  • Gastric ulcer
A
  • Occurs in stomach
  • 70% related to H. Pylori
  • Left curvature ulcer can cause hemorrhage from left gastric artery
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15
Q
  • Duodenal/Peptic Ulcer
A
  • Ulcer of the pylorus or duodenum
  • 90% related to H.Pylori
  • 65% occur on posterior wall of first part of duodenum
  • Complications
    • ​Hemorrhage from gastroduodenal a. for posterior ulcers in first part of duodenum
    • Ulcer in first part of duodenum can cause adhesions with liver and gallbladder
    • Anterior ulcer can perforate into peritoneal space
    • Pancreas may be affected
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16
Q
  • Vagotomy:
  • Types
  • What is it used to treat?
A
  • GERD
  • Truncal: Removes all nerves of the stomach and other portions of the GI tract
  • Selective Gastric: Just stomach
  • Selective Proximal: Proximal part of the stomach
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17
Q
  • Random histo question: Where are parietal cells located in the stomach? what do they do?
A
  • Fundus and body of the stomach
  • Secrete HCl
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18
Q
  • The duodenum is located on the _ plane (L3)
A
  • Subcostal
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19
Q
  • The 1st part of the duodenum is _ and the rest is _ (in terms of peritoneum)
A
  • Peritoneal
  • Retroperitoneal
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20
Q
  • Which artery is an area of concern for stab/gunshot wound victims stabbed near the duodenum?
A
  • Superior mesenteric artery
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21
Q
  • The Ligament of Treitz is a _ muscle
  • What is its function?
A
  • Suspensory
  • Separates upper and lower GI tract
  • Connects Diaphragm to Duodenum
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22
Q
  • Anterior relationship to superior duodenum
  • Posterior
  • Medial
  • Superior
  • Inferior
  • Lateral
A
  • Anterior
    • Peritoneum
    • Gallbladder
    • Quadrate lobe of liver
  • Posterior
    • Bile duct
    • Gastroduodenal Artery
    • Hepatic Portal Vein
    • IVC
  • Medial
    • Pylorus
  • Superior
    • Neck of Gallbladder
  • Inferior
    • Neck of Pancreas
  • Vertebral Level
    • L1
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23
Q
  • Descending duodenum:
  • Anterior relationship
  • Posterior relationship
  • Medial relationship
  • Superior relationship
  • Inferior relationship
  • Vertebral Level
A
  • Anterior
    • ​Transverse colon
    • Transverse mesocolon
    • Coils of small intestine
  • Posterior
    • ​Hilum of right kidney
    • Renal vessels
    • Ureter
    • Psoas Major
  • Medial
    • ​Head of Pancreas
    • Pancreatic duct
    • Bile Duct
  • Superior
    • ​Superior part of duodenum
  • Inferior
    • ​Inferior part of duodenum
  • Vertebral Level
    • ​Right of L2-L3 (Subcostal Plane)
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24
Q
  • Inferior Duodenum relationships:
  • Anterior
  • Posterior
  • Medial
  • Superior
  • Inferior
  • Vertebral Level
A
  • Anterior
    • ​SMA
    • SMV
    • Coils of small intestine
  • Posterior
    • ​Right psoas major
    • IVC
    • Aorta
    • Right ureter
  • Superior
    • ​Head and unicate process of pancreas
    • Superior mesenteric vessels
  • Inferior
    • ​Coils of small intestine (ilium)
  • Vertebral Level
    • ​Anterior to L3
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25
Q
  • Ascending duodenum relationships:
  • Anterior
  • Posterior
  • Medial
  • Superior
  • Inferior
  • Vertebral Leveln
A
  • Anterior
    • ​Beginning of root of mesentary
    • Coils of jejunum
  • Posterior
    • ​Left psoas major
    • Left margin of aorta
  • Medial
    • ​SMA
    • SMV
    • Unicate process of pancreas
  • Superior
    • ​Body of pancreas
  • Inferior
    • ​Coils of jejunum
  • Vertebral Level
    • ​Left of L3 Vertebra
26
Q
  • Most of the jejunum is in the _ quadrant
  • Most of the ileum is in the _ quadrant
  • The jejunum and ileum are attached to the posterior abdominal wall via _ which starts at which spinal level _ and ends at the _ junction at L5?
A
  • LUQ
  • RLQ
  • Mesentary
  • L2
  • Ileocecal Junction (L5)
27
Q
  • Key anatomical features of the jejunum
A
  • High vascularity
  • Long vasa recta
  • Few large loops of arcades
  • Large, tall and closely packed circular folds
  • Few lymphatic nodules (peyer’s patches)
28
Q
  • Key anatomical features of the ileum
A
  • Less vascular
  • Short Vasa Recta
  • Many short loops of arcades
  • Low and sparse circular folds (absent in distal part)
  • Many lymphatic nodules (Peyer’s Patches)
29
Q
  • Identify the portion of the small intestine shown
30
Q
  • Identify the portion of the small intestine shown below
31
Q
  • Identify the portion of the small intestine shown below
32
Q
  • Identify the portion of the small intestine shown below
33
Q
  • Meckel Diverticulum
A
  • Can be detected via technitium-99m scan (contain ectopic gastric or pancreatic tissue)
  • True diverticulum (contains mucosa, submucosa, and muscularis)
  • Most common congenital anomoly of GI tract
  • Most common pathological lead point for intussusception
  • Symptomatic when ectopic tissue is present
  • Rule of 2s:
    • 2 times more likely in males
    • 2 inches long
    • 2 ft from ileocecal valve
    • 2% pop
    • Common in first 2 years of life if symptomatic
    • 2 types of epithelium may be present
  • Sx:
    • ​Blood per rectum
    • Visible discomfort in RLQ
34
Q
  • Intussusception
A
  • Telescoping of proximal bowel segment into distal segment
  • Common at iliocecal jx
  • Shown by Target sign on US
  • Mostly Children
  • Idopethic v. Meckel (kids) v. tumor v. adults
35
Q
  • Which two structures meet at the iliocecal junction?
  • Which spinal level and plane is this located?
A
  • Ileum and cecal colon (large colon)
  • L5-Transtubercular
36
Q

Diverticulitis can cause pain in the _ of adults

A

LLQ

Patients also typically present with diarrhea

37
Q
  • Identify the following features of the large intestine
A

1) Omental appendices
2) Mesocolic tenia coli
3) Cecum
4) Haustra (not present in patients with ulcerative colitis)

38
Q
  • Where is McBurney’s Point Located? Which anatomical feature does palpation of it assess?
A
  • 1/3 of the way between right ASIS and umbilicus
  • Appendix
39
Q
  • What does Murphy’s sign test for?
A
  • Gallbladder function
  • Palpate inferior to right costal margin on inspiration and assess for discomfort
40
Q
  • Palpation below the left costal margin assesses which organ?
41
Q

3 of _ converge on the appendix

A
  • Omental tenia
42
Q
  • Features of the sigmoid colon
A
  • Located From iliac fossa to S3
  • S shaped loop
  • Teniae coli terminate at the recto-sigmoid junction
  • Has long mesentary: sigmoid mesocolon
  • Most common site of volvulus in the elderly population
43
Q
  • Volvulus
A
  • Rotation of loop of bowel
  • Can cause constipation, ischemia, and necrosis
  • Midgut volvulus more common in infants *(2/3 terminal duodenum to transverse colon)
  • Sigmoid volvulus more common in elderly
  • Coffee bean sign on X ray
44
Q
  • Key features of the liver
A
  • Largest abdominal organ
  • Occupies RUQ-can extend to left anterior axillary line if enlarged
  • top is located at xiphisternal plane (t9)
  • Will move inferiorly on inspiration which will aid palpation
  • Clinical note:
    • ​When doing biopsy, go superior to 10th rib, hold exhalation so collapsed lung will not occur
45
Q
  • What are the anatomical lobes of the liver?
  • What ligament separates them?
  • What are the accessory lobes of the right anatomic lobe?
A
  • Right and left (NO FUNCTIONAL SIGNIFICANCE)
  • Falciform Ligament
  • Quadrate lobe
    • ​Left hemi-liver
  • Caudate lobe
    • ​Functionally separate
46
Q
  • What are the main ligaments of the liver?
  • What do these ligaments connect?
A
  • Falciform ligament
    • ​Connects right and left anatomic lobes
    • Connects liver to anterior abdominal wall
  • Round ligament (Teres)​
    • ​remnant of umbilical vein
  • Ligamentum venosum
    • ​Used to be the ductus venosus that shunted blood from the fetal liver
  • Hepatoduodenal Ligament
    • ​Contains the proper hepatic artery, bile duct, and portal vein
    • Anterior boundary of epiploic foramen
47
Q
  • The _ maneuver can be used to identify if a hemorrhage is coming from the proper hepatic artery or some accessory artery to the liver
48
Q
  • FUNCTIONAL LOBES OF THE LIVER
A
  • Separated into right and left based on primary division of portal triad
  • EXCEPTION: Caudate lobe-receives blood from both portal bundles
  • Important for hepatic segmentectomies
49
Q

_ line goes from fundus of gallbladder superiorly to the diaphragm

50
Q
  • FUNCTIONAL LOBES OF THE LIVER (KNOW THIS)
51
Q
  • Key features of the gallbladder
A
  • Between IV and V segments of the liver
  • Has fundus, body, and neck
  • Attach to common bile duct via cystic duct
52
Q
  • The common bile duct meets with the _ duct and empties into the ampulla of Vater (aka the hepatopancreatic ampulla) in the second part of the duodenum
A
  • pancreatic
53
Q
  • If a gallstone or blockage occurs, which segments are affected?
A
  • Segments proximal to the blockage
54
Q

Cholelithiasis

A
  • Gallstones
  • Can lead to cholecystitis
55
Q
  • Which population is at risk for cholecystitis
  • How do you test for it?
A
  • Female, fertile, forty, fat (4 fs)
  • Murphy’s sign
    • Palpate RUQ and ask patient to inhale
    • Sudden halt of inspiration d/t pain is (+) sign
56
Q

__ is caused by an obstruction of the common bile duct_

A
  • Choledocolithiasis
57
Q
  • _ is the obstruction of the ileocecal junction from a gallstone
A
  • Gallstone ileus
  • Basically the gallstone travels down to the ileocecal valve
58
Q
  • Key features of the spleen
A
  • Largest lymphatic organ
  • LUQ
  • Vulnerable to blunt trauma
59
Q
  • Relationships of the spleen:
  • Anterior
  • Posterior
  • Inferior
  • Medial
A
  • Anterior
    • Stomach
  • Posterior
    • Diaphragm
    • Ribs 9-11
  • Inferior
    • Left colic flexure
  • Medial
    • Left kidney
60
Q
  • Ligaments of the spleen and their contents
A
  • Splenorenal ligament
    • Connects spleen to kidney
    • Contains splenic artery (main blood supply to the spleen)
  • Gastrosplenic ligament
    • ​Connects fundus of stomach to superior pole of spleen
    • Contains short gastric arteries to supply above areas

GI Exam 1 (10 decks)

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