Quiz 1 Flashcards
GI parasympathetics come from Cranial Nerves and Pelvic Splanchnic Nerves. What are the origins of these parasympathetics?
CN III, VII, IX, X
Pelvic Splanchnic: S2 - S4
Where do the Four Lumbar Splanchnic Nerves Synapse?
Intermesenteric Plexus
Anterior Aorta, between SMA and IMA
The greater omentum really forms during stomach rotation. What structure enlarges to create it?
Dorsal Mesogastrum
How does the Lateral Umbilical fold come about?
Due to Inferior Epigastric A
What are esophageal varies and how do they happen?
Dilation of the submucosal venous sinuses from increased pressure. These reside in the esophagus
What are the two targets of the T1 - T6 post-ganglionic sympathetic nerve pathway?
Up a level to the Heart
Same Level to the Lung
The Abdominal Aortic Plexus controls digestion. what three plexuses does it consist of?
Celiac
Superior Mesenteric
Inferior Mesenteric
What vertebral levels are the left and right stomach fixed to?
L: T10 - 11
R: L1
What spinal cord levels are the first and second lumbar splanchnic nerves associated with?
L1 and L2
Mass activation of sympathetic ganglia cause a heightened sense of stimulation due to stimulation of what?
RAS
If you sever the Gastrophrenic L, what blood vessel might you expect to be severed with it?
Posterior Gastric A
What does the intestine-intestinal reflex do?
an extremely distended area of the bowel will inhibit contractile activity in the rest of the bowel
What is the embryonic derivative of enteric ganglia/nerves and their glia?
Nerves: Ectoderm
Glia: NCCs
What lines the bile canaliculus?
Cholangiocytes (between adjacent hepatocytes)
Superficial lymph vessels drain into different nodes depending on their location relative to the umbilicus. Which go where?
Superior to Umbilicus: Axillary Nodes (some parasternal)
Inferior to Umbilicus: Superficial Inguinal Nodes
What two things does the peritoneum product to fight infection?
Antibodies
Leukocytes
How does the Entero-Gastric Reflex inhibit gastric emptying in response to hypertonicity in the duodenum?
nobody knows
A patient has a positive murphys sign and a painful right shoulder. What do you think it is?
Actue Cholecystitis
What stimulates the chemical trigger zone of the vomiting reflex?
Apomorphine, Morphine
What acts on the Intrinsic Primary Afferent Neuron to initiate the peristaltic reflex when signaled by distention?
Serotonin (released by enterochromaffin cells)
What two paths do Visceral Autonomic Efferents use?
Vagus or Pelvic Splanchnics
Whats the only thing Dr Dennis wants us to know about enteroendocrine cells?
They can be closed or they can open into the lumen to release their products
What landmarks do you identify to form portal lobules, destined to drain into the same bile duct?
3 Central Veins
What sandwiches the lesser peritoneal sac?
Omentum
What is the nerve root for the sympathetic innervation to the gut?
T10 - L2
What lobes does the Falciform Ligament Separate?
Left Lobe and Right Lobe
What is the embryological origin of the median umbilical fold?
Obliterated Urachus (which used to be the allantois)
What muscle does the rectus abdominis m. form?
Pyramidis m. (missing in 20% of people)
What two arteries is the Gastrocolic l. associated with?
R and L Gastroepiploic a.
What two signs would you look for to differentiate obstructing cancer of the descending colon?
Older Age pt
Possible mass to feel in the LLQ
What creates the cooling blood countercurrent for the testicles?
Pampiniform Plexus
What 5 things does the posterior vagal trunk distribute to?
Pancreas Liver Biliary System Small Intestine Proximal Large Intestine (including transverse colon)
What lymph nodes do the testes drain into?
Lumbar and Pre-Aortic lymph nodes
What do the Canals of Hering Drain into, and what is their fate?
Bile Ductules that merge and enlarge to drain into the L and R Hepatic Ductsq
The Mucosal GI Tract’s lamina propria is rich in life. What kind of things can you expect to find there?
Immune stuff (Nodules, Lymphocytes, Macrophages, Plasma cells)
What do the 3rd and 4th lumbar splanchnic nerves travel on to get to the Superior Hypogastric Plexus?
Distal Aorta (to the superior hypogastric plexus)
Where do Sacral Splanchnic Nerves Synapse?
Inferior Hypogastric Plexus
What The scrotum eventually drains into the iliac and lumbar lymph nodes. What does it pass through first to get there?
Superficial Inguinal Nodes
What are the 4 unpaired arteries of the posterior abdominal wall?
Celiac Trunk
Superior / Inferior Mesenteric As
Median Sacral A
What plexus do the 3rd and 4th lumbar splanchnic nerves synapse on?
Superior Hypogastric Plexus (or through to the ureter)
Inferior Hypogastric Plexus on anterior sacrum
When would you consider abdominal pain chronic?
After Three weeks. Before that, its acute or sub-acute
Where is Meissners Plexus?
Submucosa
What kind of pain do you observe in someone with tenderness and guarding?
Parietal
What would blood fail to reach if there was a problem with the potential space of Disse Nuts?
Hepatocytes
What glands are found in the stomach mucosa lamina propria?
Cardiac, gastric, pyloric
What proteins do we associate with sympathetic gut action?
Secretin
GIP
What do Greater Splanchnic Nerve postganglionic fibers travel with?
Branches of Celiac Trunk
What does CCK do to the stomach?
Increases distensibility
Decreases Contractions
What direction do gray rami communicates carry information vs white rami communicates?
White: Spinal nerve to Sympathetic Trunk
Grey: Sympathetic Trunk to Spinal Nerves
What are the three hallmarks of the parotid gland?
CN VII passes through it
Its is or is in Adipose tissue
Serous Only
What do the Interstitial cells of Cajal do?
Pacemaker for the GI tract (generate and propagate!)
What does the Vagovagal reflex do to the stomach?
Expands the Volume of the rOad Region
What ligament anchors the inguinal ligament to the pubis?
Lacunar L.
What three things can you find in the infra-colic compartment of the peritoneal cavity?
Small intestine
Ascending Colon and Descending colon
What is the origin and insertion of the internal oblique muscle?
Iliac Crest to ribs 10-12, linea alba, pubic crest
What gland is made from pyramidal cells?
Parotid gland
What propels the poop into the rectum to stimulate the defecation reflex?
Mass Movements
Where do the guts end up with non-rotation of the midgut loop?
Left Sided Colon
Right Sided Small Intestine
What is the common embryonic origin of the mesocolons, mesoappendix, and small intestine mesentery?
The Dorsal Mesentery
Where would you find a spigelian hernia?
Along the semilunar line of rectus abdominis
What type of hernias do the inguinal triangle get?
Direct
What separates the esophagus from the funds of the stomach?
Cardiac Notch
What part of the GI tract is the mesentery attached to?
Jejunum and Ilium (and posterior abdominal wall)
What arteries can you find o the inferior side of the diaphragm?
Inferior Phrenic (off abdominal aorta) Intercostal Branches (for the periphery)
What landmark would you find at the inferior constrictor?
Diaphragmatic Sphincter
What is the etiology of Biliary Atresia?
Obliteration of extra-hepatic and/or intra-hepatic ducts, replaced by fibrosis
What is the origin and insertion of the external oblique?
Lower 6 ribs to the linea alba, anterior iliac crest, pubic tubercle
Which Peritoneal division contains the stomach, liver, and spleen?
Supracolic
A patent has a palpable mass, or olive, at the right costal margin. what do you think is the embryonic origin of this disease?
Faulty migration of neural crest cells, therefore improper ganglion cell population
This is hypertrophic pyloric stenosis
What do Least Splanchnic Nerve postganglionic fibers travel with?
Renal Arteries
You see circular chunks in an oblique section of the GI tract. What do you think?
Cardiac Glands
What plexus controls the GI secretions and local blood flow?
Submucosal Plexus
What are the roots of the pelvic splanchnic nerves?
S2 - S4
Circular and longitudinal muscles are reciprocally innervate to oppose and compliment each others actions. What does this result in?
Peristaltic Contractions
What muscle lies directly posterior to the larges part of the kidney?
Quadratus lumborum
What incision is most typical for Ob/Gyn surgeries?
Suprapubic
What branch of the external iliac a. runs posterior to the rectus abdominis?
Inferior Epigastric a.
What do we need to trigger contractions in the small intestine if slow waves aren’t enough?
Spike Potentials. However - Slow wave frequency sets the maximum contraction frequency.
What reflex initiates mass movements and transmits via the ANS?
Gastro-colic and Duodeno-colic reflexes
What roots are the Sacral Splanchnic Nerves Associated with?
S1 to S5
Which type of liver lobule is associated with which function?
Classic: Endocrine
Portal: Exocrine
What innervates the internal oblique muscle?
T7-12 and L1
What vessels are directly anterior to the ureter?
Ductus deferens or Uterine Artery
Why does regurgitation of stomach contents happen in sliding hiatal hernias and not para esophageal hiatal hernias?
Its all about where the cardiac portion of the stomach is. Its normal in para-esophageal, but herniated in sliding hiatal hernias.
What is the relationship between gastric emptying and tone of the pylorus?
Inverse
What congenital anomaly can become inflamed and mimic acute appendicitis?
Ileal (Meckel’s) Diverticulum
Where does the Anterior Vagal Trunk Synapse?
Enteric Plexus (in stomach) to supply glands and smooth muscle
What artery is the terminal branch of the internal thoracic a?
Superior Epigastric a.
What kind of Vagotomy would you do to denervate only the Parietal cells of the stomach?
Selective Proximal Vagotomy
You can get megacolon from Hirschsprung disease. What is the embryonic origin of this disease?
Failure of NCCs to migrate and create ganglionic plexus, which also leads to hypertrophy in the segment.
How does a volvulus of the sigmoid colon occur?
Twisting of its mobile loop, obstructing it
Where might you find meconium with defects of the urorectal septum?
Rectovaginal: Vagina
Rectovesical/urethral: Urine
Where is the thoracic pain line?
Plane of sternal angle, T4 - T5
What do zymogen granules of Chief Cells store?
Pepsionigen (for conversion to pepsin)
What do the 3rd and 4th lumbar Splanchnic nerves travel on after synapsing in the Inferior Hypogastric Plexus?
Branches of Internal Iliac Artery (to get to the pelvic viscera and perineum)
What is the relationship between gastric emptying and segmentation of contractions in the intestine?
Inverse
Which Omentum is attached to the duodenum, liver, and stomach?
Lesser
A cell stores vitamin A. What do you think it is?
Hepatic Stellate Cell / Ito Cell
What structure is blocked, causing obstructive jaundice?
Common Bile Duct
What does the superficial epigastric artery come off?
Femoral A
What two arteries does the External Iliac A give off in the abdominal wall?
Deep Circumflex Iliac
Inferior Epigastric
What tendon does the internal oblique muscle make?
(part of the) Conjoint Tendon / Inguinal Falx with transversus abdominis m. contributing the rest
What quadrant holds the Ilium?
RLQ
What kind of epithelium is found in the intercalated duct of the salivary gland?
Low Cuboidal
What is the target of the T10 - L2 Splanchnic Nerve Pathway?
Down a Level to the Bladder, etc
What part of the GI tract first introduces Plicae?
Jejunum
GI Sympathetics come from lateral horn nerves and Thoracic Splanchnic Nerves. What are the roots of these?
Lateral Horn: T1 - L2
Splanchnic: T5 - L2
How does the Entero-Gastric Reflex inhibit gastric emptying in response to acid in the duodenum?
Secretin is released, which uses Gastrin to inhibit motility
What innervates the Rectus Abdominis m.?
T7-12 ventral rami
What is the main difference between slow waves in the stomach vs in the small intestine?
In the small intestine, they do not directly initiate contractions. They are always present regardless.
SADPUCKR is the acronym for retroperotineal organs. What does this stand for?
Suprarenal glands, Aorta/IVC, Duodenum (234), Pancreas(not tail), Ureters, Colon(a/d), Kidneys, Esophagus, rectum.
a pt has a connection between the tunica vaginalis and abdomen. What do we call this?
Persistent Processus Vaginalis
Where would the sudden onset of pain be in a pt with a ruptured ectopic pregnancy?
Hypogastrium radiating to sacrum
What are the two retroperitoneal viscera?
Thoracic Esophagus and Rectum
What are the two key characteristics of the Jejunum?
Villi and a lack of Submucosal Glands
Where do you find serosa vs adventitia along the GI tract?
Thoracic Esophagus is Adventitia
Inferior to Diaphragm is Serosa
What is the epithelium and core of intestinal Villi made from?
Epithelium is simple columnar with Enterocytes and Goblet
Core is Loose CT with vasculature and a Lacteal
What gland would you identify as having Serous Demilunes?
Submandibular Gland
We all know that I ate ten eggs at 12. What did I have with the eggs?
Left and Right Vagal Trunks
What two changes occur from the second, 180 degree, CCW rotation of the gut?
Cecum is brought to RUQ, for now.
What muscle creates the cremaster m.?
Internal Oblique
Both the iliohypogastric and ilioinguinal nerves supply motor to the Internal Oblique and Transversus Abdominis. They also share a common root. What is the difference in their sensory innervation?
Iliohypogastric does UPPER inguinal and hypogastric region
Ilioinguinal does LOWER inguinal, anterior scrotum/labia, and the near medial thigh.
What fascia is the scarpas fascia continuous with?
Colle’s Fascia (allows fluid to move in and out of superficial perineum)
What three things are in the female inguinal canal?
Round Ligament of the Uterus
Ilioinguinal Nerve
Genitofemoral nerve (genital branch)
What kind of epithelium is found in the excretory duct of the salivary gland?
Simple cuboidal-to-Pseudostratified Columnar
OR Stratified Cuboidal
What three layers of the abdominal wall are carried with the developing spermatic cord?
Transversalis Fascia
Internal Oblique
External Oblique
What 2 hormones “tend to inhibit contractions”?
Secretin and Glucagon
What 2 things do the least splanchnic nerve supply?
Kidneys and Adrenals
What fold would you associate the lateral inguinal fossa with?
Lateral Umbilical fold
What three things do the pelvic splanchnic nerves supply?
Descending colon to the anal canal
Urogenital Organs
Perineum organs
Which kinds of axons from the sympathetic and parasympathetic increase and decrease motility in the GI tract?
Preganglionic Increase Motility (parasympathetic)
Postganglionic Decrease Motility (sympathetic)
Cryptorchid Testes means they remain undescended. What does this worry us about down the road?
Testicular Cancer
What is the hallmark of Large Intestine Histology?
Crypts of Lieberkühn, Glands, goblet cells
NO villi
What vasculature supplies the rectum (endoderm) vs the anus (ectoderm)?
Rectum: Superior and middle rectal A/V of hindgut
Anus: Inferior Rectal A/V
We all know that I ate ten eggs at 12. What else ate ten eggs at 12?
Right Phrenic Nerve
Where does the Least Splanchnic Nerve Synapse?
Aorticorenal Ganglion
The urorectal septum forms what you’d expect - the dorsal anorectal canal and ventral urogenital sinus. What is is partitioning to make these structures?
Cloaca
What are the two components of the lesser omentum?
Hepato-duodenal Ligament
Hepato-gastric Ligament
What two landmarks would you find at the middle constrictor?
Aorta, Left main bronchi
Meckels diverticulum causes abdominal swelling, intestinal abstraction, and bowel sepsis. How does it happen?
The Yolk Stalk (vitelline duct) connection to the midgut regresses
What are patients with a pancreas divisor more prone to?
Pancreatitis
What fold would you associate with the medial umbilical fossa?
Medial Umbilical Fold
What Quadrant holds the Jejunum
LUQ
Hirschpring’s Disease, or “achalasia of the ass”, sees absent ganglion cells and low VIP. How would you treat it?
Surgical Resection of the colon segment lacking ganglia and, presumably, filled with poo.
What is the root of the thoracoabdominal nerve?
T7-11
What is the role of the muscular mucosase?
Controls the mobility of mucosa / mucosal glands
The three ligaments of the liver share the same structural embryonic origin. What is it?
Ventral Mesentery
What is the target of the T5 - L2 Splanchnic Nerve Pathway?
Same Level to the Small Intestine, etc
What two plexuses control the urinary and reproductive functions (by innervating the pelvic viscera)?
Superior and Inferior Hypogastric Plexuses
What organs are responsible for periumbilical pain?
Midgut organs (small bowel, appendix, cecum)
What spinal cord levels does the adrenal medulla pathway arise from?
T8 - L1
What is a volvulus?
Rolled up and twisted intestines
What is the most superficial layer of the GI tract?
Serosa / Adventitia
What do the peritoneal sacs use to communicate?
the Epiploic Foramen
What two things do Paneth cells release to do antimicrobial action?
Lysozyme
a-Defensins
What comes together to form the Hepatopancreatic Ampulla?
Common Bile Duct
Main Pancreatic Duct
If the Superior mesenteric plexus does sympathetic innervation to Proximal regions and the Inferior does Distal regions, what does the Hypogastric Plexus do?
Distal Rectum and Anal Canal
What does the Gubernaculum become?
Ovarian Ligament and Round Ligament of the uterus
What is the origin of the Round Ligament?
Obliterated Umbilical Vein
What three structures refer pain to the back?
The Retroperitoneal ones: Pancreas, Kidney, Aorta
The gut lumen is temporarily obliterated to accommodate the endodermal proliferation. What disease is linked with its failure to recanalize?
Trisomy 21
What is the root of the genitofemoral n.?
L1 and L2
What is the order of duct structures that substances pass through?
Acinus, Intercalated duct, Striated duct, excretory duct
What do the testes descend through, into the future scrotum?
Processus Vaginalis (outpocket of peritoneal cavity)
Where do the common iliac lymph nodes drain into?
Lumbar Lymph nodes
What type of hernia would you associate with the deep inguinal ring?
Indirect
What does the round ligament attach to during ovarian descent?
Labial swellings
What ligament forms as the quadrates lumborum fascia thickens?
Lateral Arcuate Ligament
What forms the lateral border of the rectus abdominis m?
Linea Semilunaris
What kind of Vagotomy would you do to denervate only the stomach?
Proximal Gastric Vagotomy
Where does the Lesser Splanchnic Nerve synapse?
Superior Mesenteric Ganglion
A patient has developed gallstones from their inflamed gallbladder. What do you think was the target of the initial bacterial accumulation?
Rokitansky-Aschoff Sinuses
Where do the guts end up in a reverse (180 deg) gut rotation?
Transverse colon is behind the duodenum
What determines the length of of a slow wave contraction?
Number of action potentials (more means longer)
What physical finding can you palpate in the case of a leaking aortic aneurism?
Its impulse in the epigastrium
What ligament forms the epiploic foramen?
Hepato-Duodenal Ligament
What explains why the parasympathetic nervous system doesn’t see the same mass activation as the sympathetic?
Lack of Extensive Divergence in preganglionic axons
What ligament are the right and left gastric arteries associated with?
Hepatogastric L
What does NE do to slow waves?
Decreases the Amplitude
What diaphragmatic ligament unites the left and right crura?
Median Arcuate l. Crossing the Aorta
What is the hallmark of Chief Cells?
Lots of RER and Apical Secretory Granules (zymogen)
What exits through the superficial ring?
Spermatic cord or round ligament
Where in Hasselbach’s (inguinal) triangle would you get a direct hernia?
Medial to the inferior epigastric a.
What does the Superficial Circumflex iliac artery come off?
Femoral A
What glands would you find deep to the submucosa in the duodenum, and what do they do?
Brunners Glands that neutralize the acidic Chyme
We all know that chronic GERD causes Barrett’s esophagus, but how would we know it when we see it?
Non-Keratinized Stratified Squamous in the Transition Zone (from esophagus to stomach) becomes Columnar and Glandular
Something relaxes and something contracts in the rectosphincteric reflex. “Butt” what?
Smooth muscle wall of rectum contracts
Internal anal sphincter relaxes
What ligament is a continuation of fibers from the lacunar ligament, running along the pectin pubis?
Pectineal Ligament
What plane does the Iliocecal junction lie in?
Transtubercle Plane
What is the major difference between gastroschiscis and omhalocele?
Gastroschiscis has no peritoneal covering!
What is the Embryonic tissue consolidates in the dorsal mesogastrium to form the spleen?
Mesenchyme (derived from mesoderm)
Decreased number of ganglion cells and inhibitory (NO / VIP) ganglions and damage to esophagus nerves can result in what condition?
Achalasia
What V/A pair is behind the tail of the pancreas?
Splenic A/V
What innervates the adrenal gland?
Celiac Plexus
Abdominopelvic Splanchnic nerves
What accumulates in a hydrocele, and within what structure?
Peritoneal Fluid accumulation in the Tunica Vaginalis
What nervous GI component is found beneath the tenea coli?
ENS / Myenteric Plexus
What organs are responsible for pain in the epigastric region?
Foregut (stomach, duodenum, biliary tract)
Where do the lumbar arteries come off?
Abdominal Aorta
What innervates the external anal sphincter?
Somatic Pudendal Nerves
What is the rectus abdominis in contact with below the arcuate line?
Transversalis Fascia
What does the Myenteric Plexus (Auerbach’s) control?
GI Movements
What is the target of the T1 - T4 post-ganglionic sympathetic nerve pathway?
Up a Level to the Salivary Gland, etc
What are the respective blood supplies to the developing foregut, midgut, and hindgut?
Foregut: Celiac Trunk
Midgut: SMA
Hindgut: IMA
What area of the abdomen will be tender in the case of a leaking aortic aneurism?
Epigastrium
What innervates the appendix?
Subcostal N (T12)
What fascia is fused with the fascia lata of the lower limb?
Scarpas (makes it so fluid cant pass from abdomen to leg)
What vertebral level is the sigmoid / rectum junction?
S3
What are the greater vs lesser omentum embryonic derivatives?
Greater Omentum: Dorsal Mesentery
Lesser Omentum: Ventral Mesentery
What hernia originates from a weakness in the wall at the midline fusion point?
Epigastric
What liver fissure contains the gall bladder and IVC?
Right Sagittal Fissure
Where is peritonitis localized to in a pt with a ruptured ectopic pregnancy?
Suprapubic (hypogastric) area
What do the rami communicates connect?
Spinal nerves (white T1 - L2 only) to the sympathetic trunk
What does the gubernaculum connect?
Gonads to future scrotal swellings
What is contained within the appendix to give it function?
Lymphoid Nodules
What is the protective type of mucosa in the GI tract, and where is it found?
Nonkeratinized Strat Squam
in the mouth, pharynx, and anus
The liver starts as a diverticulum, and then forms its components from both endoderm and splanchnic mesoderm. What are the endoderm parts?
Hepatocytes
Bile Ducts
Hepatic Ducts
What is the root of the subcostal nerve?
T12
What is the general demarcation of parasympathetic innervation by the vagus nerve vs pelvic splanchnic nerves?
Vagus nerve in the thorax and abdominal organs until the left colic flexure, then pelvic splanchnic nerves take over
Which Omentum is attached to the duodenum, transverse colon and stomach?
Greater
What does the Inguinal Ligament attach to?
ASIS and Pubic Tubercle
What has to rupture to allow the Urogenital sinus and anal canal to be open to the exterior?
Cloacal Membrane
What 4 hormones “tend to stimulate contractions”?
Gastrin
CCK
Motilin
Insulin
What artery is the root of the mesentery associated with?
ileocolic a.
What type of fibers dominate the stomach mucosa?
Reticular and Collagen
The pancreas is often confused with the parotid. What two types of cells would you identify the pancreas by using stain?
Acinar Cells (intense stain) Centroacinar Cells (light stain)
What two parts of the Liver’s visceral surface are not covered with peritoneum?
At the gall bladder and Porta Hepatis
What is the lowest derivative of the foregut?
Upper Duodenum
What parts of the GI tract does the Vagus nerve give parasympathetics to?
Cecum, Ascending and Transverse Colon
What does having a hairy chest reduce your chances of?
Cerrhosis
Where are the majority of Hirschprung resections?
Short Segment in rectosigmoid region
What are the 4 Secondarily retroperitoneal viscera?
Duodenum
Pancreas
Ascending and descending colon
What joints the Aorta at its diaphragmatic opening at T12?
Thoracic Duct
sometimes azygous and hemiazygous
What creates the arrangement of different cells around the sinusoids of adjacent liver lobules?
[O2] gradient created by arterial blood flow
Where would you find Microfold Cells?
Ileal Mucosa, atop Peyers Patches
What two structures come together to form the Hepatopancreatic Ampulla (of oddi)?
Bile Duct (of the gallbladder) and Main Pancreatic Duct
Hepatocytes are arranged into plates, supported by reticular fibers, and separated by sinusoids. What are these plates arranged around?
Central Vein
What does the inferior epigastric a anastamose with?
Superior Epigastric a.
Hepatocytes are arranged in cords within the liver. what do they secrete?
Bile
A patient has cramp-like (colicky) pain. What type of thing does this come from?
Obstructions of hollow muscular viscus (bowel, ureter)
Passing a kidney stone hurts like hell. Where would a patient have pain that leads you to suspect it as a diagnosis?
Back
What 3 things do the Lesser Splanchnic Nerve Supply?
Jejunum and Ilium
Cecum
Ascending and Transverse Colon
What are all the lymphatics of the posterior abdominal wall collected into?
Cisterni chyli
What is the significance of the midgut returning to its cavity after all that rotation?
The cecum comes into the Right LOWER quadrant, bringing the ascending colon with it (so it ends up along the right side of the abdomen)
The liver starts as a diverticulum, and then forms its components from both endoderm and splanchnic mesoderm. What are the mesoderm parts?
Stromal Cells
Kupffer Cells
Stellate Cells
How does the Entero-Gastric Reflex inhibit gastric emptying in response to fats in the duodenum?
CCK and GIP are released, directly inhibiting motility.
What do the descending and sigmoid colon and rectum get their parasympathetics from?
Pelvic nerves S2-S4
Which liver fissure contains the ligamentum teres?
Left Sagittal fissure
What is the root of the ilioinguinal n..
L1
If you have an accessory pancreatic duct, how did it get there?
Dorsal Pancreatic duct remains connected to the duodenum when it reconnects to the ventral pancreatic duct
Which kind of peristaltic wave can occur after Vagotomy?
Secondary (also controlled by ENS, not just medulla)
What does the internal vs external spermatic facia come from?
Internal is from the Transversalis fascia
External is from the External Oblique
Innocuous imput usually travels via parasympathetics and pain usually travels via sympathetics. What is the exception?
Below the pelvic pain line (middle of the sigmoid colon)
Pain travels with with Parasympathetics
What two landmarks would you find at the superior constrictor?
Cricoid cartilage, pharynx
What does the genitofemoral n. supply?
Motor to Cremaster
Sensory to medial thigh and scrotum / Labia
What plane do you find at the 8th rib / L1?
Transpyloric Plane
What type of incision do you associate with McBurneys point (appendectomy)?
Gridline
What do the apical surface receptors of M cells bind?
Gram Negative Bacteria (E Coli) and Certain Macromolecules
Where would you expect to find cardiac esophageal glands?
Lamina propria of Terminal Esophagus (protective)
What are the arteries (and their branches) that supply the jejunum?
Arcades and their branches (vasa rectae)
What is the origin of the Vagus nerve?
Dorsal Motor Nucleus (medulla)
You can have low, intermediate, and high Imperforated Anus. Where is the Distinction?
Relative to the Levator Ani and pelvic bony landmarks
What does ACh do to slow waves?
Increases the Amplitude
What part of the mucosa can you find the muscular mucosae of the esophagus?
Lower segment only
What are the two targets of the spinal nerve pathway (sympathetic)?
Blood Vessels
Arrector Pili
What structures do ducts use to propel products?
Myoepithelial cells
What does the gastro-enteric (gastro-ileal) reflex do?
gastric distention relaxes ileocecal sphincter
Where in the inguinal / hasselbach’s triangle would you get a femoral hernia?
Below the inguinal ligament
How do you get Barretts Esophagus?
GERD
What structural difference allows sympathetic information from the thoracolumbar regions to be carried all throughout the body?
Gray rami are connected to all spinal nerves, not just T1 - L2 like white rami.
What three structures grow into the Ventral Mesentery for pancreas formation?
Cystic Diverticulum
Ventral Pancreatic Bud
Endodermal Bud
What does the Migrating Motor Complex do?
Empties large particles of undigested reside
You see a big cell thats crazy fucking eosinophilic. What is it and how did it get So. Damn. Eosinophilic.
Parietal cells with their beaucoup Mitochondria
Lateral body folding / fusion can be abnormal. CT of skin and by-axial musculature of the body wall can be abnormal. What would either of these result in?
Omphalocele
What abdominal ligament would you associate with high speed collisions?
Suspensory Ligament of Duodenum (Treitz)
What abdominal complaint is suggested by previous history of surgery?
Adhesive small bowel obstruction
What happens in the absence of the MMC?
Small Intestinal Bacterial Overgrowth (colon bacteria in the small intestine)
Sx: Neonatal jaundice, white clay colored stools, dark urine. Whats the Disease and treatment?
Biliary Atresia
Liver Transplant
What is the origin of the iliopubic tract?
thickened Transversalis Fascia on the floor of the inguinal canal
What ligament forms as the psoas fascia thickens?
Medial Arcuate L.
Which branch of the external iliac a. runs deep along the inguinal ligament?
Deep Circumflex Iliac a.
What innervates the Transversus Abdominis m?
T7 - L1
Zymogen granules contain digestive enzymes. What type of cell would you expect to see them in?
Pancreatic Acinar Cells
What proteins do we associate with parasympathetic gut action?
Gastrin
Motilin
What are the three constriction sites of the ureter?
Its junction with the Renal Pelvis
Crossing the Pelvic Brim
Entering the Bladder Wall
Besides injury to the Vagus nerve, what disease can cause Gastroparesis?
DM 1
What do Lesser Splanchnic Nerve postganglionic fibers travel with?
Branches of the SMA
Where does the duodenal obstruction or stenosis have to happen to give a paten bilious vomiting with their annular pancreas?
Inferior to bile duct
Where do the midgut derivatives start and end?
Starts at the lower duodenum
Ends at the proximal 2/3 of the transverse colon
What do M Cells Do?
Antigen Transport
What four things do you associate with enteroendocrine cell release?
Gastrin
Secretin
GIP
CCK
What separates the right and left liver?
Cantlie Line
The limited abdominal space means the gut has to herniate out. What happens if theres a problem with it going back in?
You get Omphalocele
Where do Splanchnic nerves terminate?
Pre-Vertebral Ganglia
Where would you find the Myenteric Plexus of Auerbach?
Between the Inner Circular and Outer Longitudinal layers of Muscularis
Where does the greater splanchnic nerve synapse?
celiac ganglion
What segments are in the left liver?
I - IV
What week is bile formed by the hepatic cells?
Week 12 on
What is the main histological differences within the gallbladder, and where are they?
Against the Liver: External Adventita
Exposed to Peritoneal Cavity: Serosa
What roots are the 3rd and 4th Lumbar Splanchnic nerves associated with?
3rd: L3
4th: L4 and L5
What organs are responsible for pain (initially) in the suprapubic or hypogastric areas?
Hindgut organs (most of colon, half of sigmoid)
What kind of epithelium is found in the striated duct of the salivary gland?
Simple Cuboidal-to-Columnar
Where do the hindgut derivatives start?
Distal 1/3 of the transverse colon
Where do the L and R vagus nerves and lesser sac end up after the first 90 degrees of stomach rotation?
Left is Ventral
R is dorsal
Lesser sac is behind it
If you stuck a pin through the layers surrounding the descending testes, what structures would it pass through (superficial to deep)?
External Oblique, Internal Oblique, Transversus Abdominis
Transversalis Fascia, Subserous Fascia, Peritoneum
Simple Columnar is found in the stomach, and both large and small intestines. What is the functional and structural differences between these?
Stomach: Secretory with glands
Small Intestine: Absorptive with villi and crypts
Large Intestine: Does both with Goblet cells
What happens with Cholelithiasis to cause pancreatitis?
Gall stone blocking the hepatopancreatic ampulla, which means both the common bile duct and main pancreatic duct are blocked.
What do the bile canaliculi drain into?
Canals of Hering
What is the ratio of oxygen/nutrients by zone in the hepatic acinus?
Zone 1: High [o2 / nutrients]
Zone 3: Low [o2 / nutrients}
What plane does the transverse colon lie in?
Subcostal Plane
What is the functional unit of the Exocrine pancreas?
Serous Acinus
What is the root of the iliohypogastric n?
L1
What is the fate of the processus vaginalis?
Becomes Tunica Vaginalis
What lobes does the porta hepatis separate?
Caudate and Quadrate
The embryonic derivatives of the anal canal is divided into thirds. What are they?
Top 2/3 is endoderm
Lower 1/3 is ectoderm
What does somatic pain come from?
Parietal Peritoneum irritation because the diseased organ is creating friction
What is the embryological origin of the medial umbilical fold?
Obliterated Umbilical Arteries
What ligaments are made by the external oblique?
Inguinal Ligament
Lacunar Ligament
Opening of superficial inguinal ring
in the 5th week of development, the ventral pancreas migrates posteriorly to fuse with what?
Dorsal Pancreas to form the head, body, tail
Ventral pancreas to form Uncinate process
the first two Lumbar splanchnic nerves are distributed with branches of the IMA. What three places do they go?
Descending Colon
Sigmoid Colon
Proximal Rectum
What is the hallmark of Colon histology?
Simple Columnar glands with lots and lots of Goblet Cels
What do the sacral Splanchnic Nerves ride to get to the pelvic visceral and perineum?
Internal Iliac Artery
The muscularis of the esophagus is divided into thirds. What kinds of muscle do you find throughout?
Starts as Skeletal in the upper third, combines with smooth in the middle, and is exclusively smooth in the lower 1/3
Which segments are in the Right Liver?
V - VIII
What two conditions can create a secondary peristaltic wave?
Primary wave fails to empty the esophagus
Gastic contents reflux into the esophagus
Which type of pain can be localized to its corresponding dermatome?
Parietal
The anal transition zone separates the epithelium across the pectinate line. Whats the difference on the inside vs out?
Inside is simple columnar
Outside is stratified squamous
What three GI elements does the splanchnic mesoderm form?
Muscular wall
Vascular Elements
Connective Tissue Elements
What modulates the MMC?
Motilin
What innervates the external oblique?
Ventral rami of T7 - 12 intercostal n.
What Arteries can you find on the superior side of the diaphragm?
Musculophrenic and pericardiacophrenic (off int thor) Superior Phrenic (off thoracic aorta)
What plane does the appendix and sigmoid colon lie in?
Interspinous Plane
What three ganglia are considered pre-vertebral?
Celiac and the mesenteries
The serosa layer is made of Mesothelium. When would you see this on the digestive tube?
When its suspended by a mesentery / peritoneal fold. Otherwise, they have an adventitia.
What is the role of cells that distinguish the hepatic sinusoids?
Phagocytosis (they’re stellate macrophages)
This is Kupffer cells
What fold would you associate with the supravesicular fossa?
Median Umbilical Fold
What happens with the obliques and transversus abdominis at the arcuate line?
They all become anterior to the rectus abdominis
