Quiz 1 Flashcards
1
Q
GI parasympathetics come from Cranial Nerves and Pelvic Splanchnic Nerves. What are the origins of these parasympathetics?
A
CN III, VII, IX, X
Pelvic Splanchnic: S2 - S4
2
Q
Where do the Four Lumbar Splanchnic Nerves Synapse?
A
Intermesenteric Plexus
Anterior Aorta, between SMA and IMA
3
Q
The greater omentum really forms during stomach rotation. What structure enlarges to create it?
A
Dorsal Mesogastrum
4
Q
How does the Lateral Umbilical fold come about?
A
Due to Inferior Epigastric A
5
Q
What are esophageal varies and how do they happen?
A
Dilation of the submucosal venous sinuses from increased pressure. These reside in the esophagus
6
Q
What are the two targets of the T1 - T6 post-ganglionic sympathetic nerve pathway?
A
Up a level to the Heart
Same Level to the Lung
7
Q
The Abdominal Aortic Plexus controls digestion. what three plexuses does it consist of?
A
Celiac
Superior Mesenteric
Inferior Mesenteric
8
Q
What vertebral levels are the left and right stomach fixed to?
A
L: T10 - 11
R: L1
9
Q
What spinal cord levels are the first and second lumbar splanchnic nerves associated with?
A
L1 and L2
10
Q
Mass activation of sympathetic ganglia cause a heightened sense of stimulation due to stimulation of what?
A
RAS
11
Q
If you sever the Gastrophrenic L, what blood vessel might you expect to be severed with it?
A
Posterior Gastric A
12
Q
What does the intestine-intestinal reflex do?
A
an extremely distended area of the bowel will inhibit contractile activity in the rest of the bowel
13
Q
What is the embryonic derivative of enteric ganglia/nerves and their glia?
A
Nerves: Ectoderm
Glia: NCCs
14
Q
What lines the bile canaliculus?
A
Cholangiocytes (between adjacent hepatocytes)
15
Q
Superficial lymph vessels drain into different nodes depending on their location relative to the umbilicus. Which go where?
A
Superior to Umbilicus: Axillary Nodes (some parasternal)
Inferior to Umbilicus: Superficial Inguinal Nodes
16
Q
What two things does the peritoneum product to fight infection?
A
Antibodies
Leukocytes
17
Q
How does the Entero-Gastric Reflex inhibit gastric emptying in response to hypertonicity in the duodenum?
A
nobody knows
18
Q
A patient has a positive murphys sign and a painful right shoulder. What do you think it is?
A
Actue Cholecystitis
19
Q
What stimulates the chemical trigger zone of the vomiting reflex?
A
Apomorphine, Morphine
20
Q
What acts on the Intrinsic Primary Afferent Neuron to initiate the peristaltic reflex when signaled by distention?
A
Serotonin (released by enterochromaffin cells)
21
Q
What two paths do Visceral Autonomic Efferents use?
A
Vagus or Pelvic Splanchnics
22
Q
Whats the only thing Dr Dennis wants us to know about enteroendocrine cells?
A
They can be closed or they can open into the lumen to release their products
23
Q
What landmarks do you identify to form portal lobules, destined to drain into the same bile duct?
A
3 Central Veins
24
Q
What sandwiches the lesser peritoneal sac?
A
Omentum
25
What is the nerve root for the sympathetic innervation to the gut?
T10 - L2
26
What lobes does the Falciform Ligament Separate?
Left Lobe and Right Lobe
27
What is the embryological origin of the median umbilical fold?
Obliterated Urachus (which used to be the allantois)
28
What muscle does the rectus abdominis m. form?
Pyramidis m. (missing in 20% of people)
29
What two arteries is the Gastrocolic l. associated with?
R and L Gastroepiploic a.
30
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
31
What creates the cooling blood countercurrent for the testicles?
Pampiniform Plexus
32
What 5 things does the posterior vagal trunk distribute to?
```
Pancreas
Liver
Biliary System
Small Intestine
Proximal Large Intestine (including transverse colon)
```
33
What lymph nodes do the testes drain into?
Lumbar and Pre-Aortic lymph nodes
34
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
35
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)
36
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)
37
Where do Sacral Splanchnic Nerves Synapse?
Inferior Hypogastric Plexus
38
What The scrotum eventually drains into the iliac and lumbar lymph nodes. What does it pass through first to get there?
Superficial Inguinal Nodes
39
What are the 4 unpaired arteries of the posterior abdominal wall?
Celiac Trunk
Superior / Inferior Mesenteric As
Median Sacral A
40
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
41
When would you consider abdominal pain chronic?
After Three weeks. Before that, its acute or sub-acute
42
Where is Meissners Plexus?
Submucosa
43
What kind of pain do you observe in someone with tenderness and guarding?
Parietal
44
What would blood fail to reach if there was a problem with the potential space of Disse Nuts?
Hepatocytes
45
What glands are found in the stomach mucosa lamina propria?
Cardiac, gastric, pyloric
46
What proteins do we associate with sympathetic gut action?
Secretin
| GIP
47
What do Greater Splanchnic Nerve postganglionic fibers travel with?
Branches of Celiac Trunk
48
What does CCK do to the stomach?
Increases distensibility
| Decreases Contractions
49
What direction do gray rami communicates carry information vs white rami communicates?
White: Spinal nerve to Sympathetic Trunk
Grey: Sympathetic Trunk to Spinal Nerves
50
What are the three hallmarks of the parotid gland?
CN VII passes through it
Its is or is in Adipose tissue
Serous Only
51
What do the Interstitial cells of Cajal do?
Pacemaker for the GI tract (generate and propagate!)
52
What does the Vagovagal reflex do to the stomach?
Expands the Volume of the rOad Region
53
What ligament anchors the inguinal ligament to the pubis?
Lacunar L.
54
What three things can you find in the infra-colic compartment of the peritoneal cavity?
Small intestine
| Ascending Colon and Descending colon
55
What is the origin and insertion of the internal oblique muscle?
Iliac Crest to ribs 10-12, linea alba, pubic crest
56
What gland is made from pyramidal cells?
Parotid gland
57
What propels the poop into the rectum to stimulate the defecation reflex?
Mass Movements
58
Where do the guts end up with non-rotation of the midgut loop?
Left Sided Colon
| Right Sided Small Intestine
59
What is the common embryonic origin of the mesocolons, mesoappendix, and small intestine mesentery?
The Dorsal Mesentery
60
Where would you find a spigelian hernia?
Along the semilunar line of rectus abdominis
61
What type of hernias do the inguinal triangle get?
Direct
62
What separates the esophagus from the funds of the stomach?
Cardiac Notch
63
What part of the GI tract is the mesentery attached to?
Jejunum and Ilium (and posterior abdominal wall)
64
What arteries can you find o the inferior side of the diaphragm?
```
Inferior Phrenic (off abdominal aorta)
Intercostal Branches (for the periphery)
```
65
What landmark would you find at the inferior constrictor?
Diaphragmatic Sphincter
66
What is the etiology of Biliary Atresia?
Obliteration of extra-hepatic and/or intra-hepatic ducts, replaced by fibrosis
67
What is the origin and insertion of the external oblique?
Lower 6 ribs to the linea alba, anterior iliac crest, pubic tubercle
68
Which Peritoneal division contains the stomach, liver, and spleen?
Supracolic
69
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
70
What do Least Splanchnic Nerve postganglionic fibers travel with?
Renal Arteries
71
You see circular chunks in an oblique section of the GI tract. What do you think?
Cardiac Glands
72
What plexus controls the GI secretions and local blood flow?
Submucosal Plexus
73
What are the roots of the pelvic splanchnic nerves?
S2 - S4
74
Circular and longitudinal muscles are reciprocally innervate to oppose and compliment each others actions. What does this result in?
Peristaltic Contractions
75
What muscle lies directly posterior to the larges part of the kidney?
Quadratus lumborum
76
What incision is most typical for Ob/Gyn surgeries?
Suprapubic
77
What branch of the external iliac a. runs posterior to the rectus abdominis?
Inferior Epigastric a.
78
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.
79
What reflex initiates mass movements and transmits via the ANS?
Gastro-colic and Duodeno-colic reflexes
80
What roots are the Sacral Splanchnic Nerves Associated with?
S1 to S5
81
Which type of liver lobule is associated with which function?
Classic: Endocrine
Portal: Exocrine
82
What innervates the internal oblique muscle?
T7-12 and L1
83
What vessels are directly anterior to the ureter?
Ductus deferens or Uterine Artery
84
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.
85
What is the relationship between gastric emptying and tone of the pylorus?
Inverse
86
What congenital anomaly can become inflamed and mimic acute appendicitis?
Ileal (Meckel's) Diverticulum
87
Where does the Anterior Vagal Trunk Synapse?
Enteric Plexus (in stomach) to supply glands and smooth muscle
88
What artery is the terminal branch of the internal thoracic a?
Superior Epigastric a.
89
What kind of Vagotomy would you do to denervate only the Parietal cells of the stomach?
Selective Proximal Vagotomy
90
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.
91
How does a volvulus of the sigmoid colon occur?
Twisting of its mobile loop, obstructing it
92
Where might you find meconium with defects of the urorectal septum?
Rectovaginal: Vagina
| Rectovesical/urethral: Urine
93
Where is the thoracic pain line?
Plane of sternal angle, T4 - T5
94
What do zymogen granules of Chief Cells store?
Pepsionigen (for conversion to pepsin)
95
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)
96
What is the relationship between gastric emptying and segmentation of contractions in the intestine?
Inverse
97
Which Omentum is attached to the duodenum, liver, and stomach?
Lesser
98
A cell stores vitamin A. What do you think it is?
Hepatic Stellate Cell / Ito Cell
99
What structure is blocked, causing obstructive jaundice?
Common Bile Duct
100
What does the superficial epigastric artery come off?
Femoral A
101
What two arteries does the External Iliac A give off in the abdominal wall?
Deep Circumflex Iliac
| Inferior Epigastric
102
What tendon does the internal oblique muscle make?
(part of the) Conjoint Tendon / Inguinal Falx with transversus abdominis m. contributing the rest
103
What quadrant holds the Ilium?
RLQ
104
What kind of epithelium is found in the intercalated duct of the salivary gland?
Low Cuboidal
105
What is the target of the T10 - L2 Splanchnic Nerve Pathway?
Down a Level to the Bladder, etc
106
What part of the GI tract first introduces Plicae?
Jejunum
107
GI Sympathetics come from lateral horn nerves and Thoracic Splanchnic Nerves. What are the roots of these?
Lateral Horn: T1 - L2
| Splanchnic: T5 - L2
108
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
109
What innervates the Rectus Abdominis m.?
T7-12 ventral rami
110
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.
111
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.
112
a pt has a connection between the tunica vaginalis and abdomen. What do we call this?
Persistent Processus Vaginalis
113
Where would the sudden onset of pain be in a pt with a ruptured ectopic pregnancy?
Hypogastrium radiating to sacrum
114
What are the two retroperitoneal viscera?
Thoracic Esophagus and Rectum
115
What are the two key characteristics of the Jejunum?
Villi and a lack of Submucosal Glands
116
Where do you find serosa vs adventitia along the GI tract?
Thoracic Esophagus is Adventitia
| Inferior to Diaphragm is Serosa
117
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
118
What gland would you identify as having Serous Demilunes?
Submandibular Gland
119
We all know that I ate ten eggs at 12. What did I have with the eggs?
Left and Right Vagal Trunks
120
What two changes occur from the second, 180 degree, CCW rotation of the gut?
Cecum is brought to RUQ, for now.
121
What muscle creates the cremaster m.?
Internal Oblique
122
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.
123
What fascia is the scarpas fascia continuous with?
Colle's Fascia (allows fluid to move in and out of superficial perineum)
124
What three things are in the female inguinal canal?
Round Ligament of the Uterus
Ilioinguinal Nerve
Genitofemoral nerve (genital branch)
125
What kind of epithelium is found in the excretory duct of the salivary gland?
Simple cuboidal-to-Pseudostratified Columnar
| OR Stratified Cuboidal
126
What three layers of the abdominal wall are carried with the developing spermatic cord?
Transversalis Fascia
Internal Oblique
External Oblique
127
What 2 hormones "tend to inhibit contractions"?
Secretin and Glucagon
128
What 2 things do the least splanchnic nerve supply?
Kidneys and Adrenals
129
What fold would you associate the lateral inguinal fossa with?
Lateral Umbilical fold
130
What three things do the pelvic splanchnic nerves supply?
Descending colon to the anal canal
Urogenital Organs
Perineum organs
131
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)
132
Cryptorchid Testes means they remain undescended. What does this worry us about down the road?
Testicular Cancer
133
What is the hallmark of Large Intestine Histology?
Crypts of Lieberkühn, Glands, goblet cells
| NO villi
134
What vasculature supplies the rectum (endoderm) vs the anus (ectoderm)?
Rectum: Superior and middle rectal A/V of hindgut
Anus: Inferior Rectal A/V
135
We all know that I ate ten eggs at 12. What else ate ten eggs at 12?
Right Phrenic Nerve
136
Where does the Least Splanchnic Nerve Synapse?
Aorticorenal Ganglion
137
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
138
What are the two components of the lesser omentum?
Hepato-duodenal Ligament
| Hepato-gastric Ligament
139
What two landmarks would you find at the middle constrictor?
Aorta, Left main bronchi
140
Meckels diverticulum causes abdominal swelling, intestinal abstraction, and bowel sepsis. How does it happen?
The Yolk Stalk (vitelline duct) connection to the midgut regresses
141
What are patients with a pancreas divisor more prone to?
Pancreatitis
142
What fold would you associate with the medial umbilical fossa?
Medial Umbilical Fold
143
What Quadrant holds the Jejunum
LUQ
144
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.
145
What is the root of the thoracoabdominal nerve?
T7-11
146
What is the role of the muscular mucosase?
Controls the mobility of mucosa / mucosal glands
147
The three ligaments of the liver share the same structural embryonic origin. What is it?
Ventral Mesentery
148
What is the target of the T5 - L2 Splanchnic Nerve Pathway?
Same Level to the Small Intestine, etc
149
What two plexuses control the urinary and reproductive functions (by innervating the pelvic viscera)?
Superior and Inferior Hypogastric Plexuses
150
What organs are responsible for periumbilical pain?
Midgut organs (small bowel, appendix, cecum)
151
What spinal cord levels does the adrenal medulla pathway arise from?
T8 - L1
152
What is a volvulus?
Rolled up and twisted intestines
153
What is the most superficial layer of the GI tract?
Serosa / Adventitia
154
What do the peritoneal sacs use to communicate?
the Epiploic Foramen
155
What two things do Paneth cells release to do antimicrobial action?
Lysozyme
| a-Defensins
156
What comes together to form the Hepatopancreatic Ampulla?
Common Bile Duct
| Main Pancreatic Duct
157
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
158
What does the Gubernaculum become?
Ovarian Ligament and Round Ligament of the uterus
159
What is the origin of the Round Ligament?
Obliterated Umbilical Vein
160
What three structures refer pain to the back?
The Retroperitoneal ones: Pancreas, Kidney, Aorta
161
The gut lumen is temporarily obliterated to accommodate the endodermal proliferation. What disease is linked with its failure to recanalize?
Trisomy 21
162
What is the root of the genitofemoral n.?
L1 and L2
163
What is the order of duct structures that substances pass through?
Acinus, Intercalated duct, Striated duct, excretory duct
164
What do the testes descend through, into the future scrotum?
Processus Vaginalis (outpocket of peritoneal cavity)
165
Where do the common iliac lymph nodes drain into?
Lumbar Lymph nodes
166
What type of hernia would you associate with the deep inguinal ring?
Indirect
167
What does the round ligament attach to during ovarian descent?
Labial swellings
168
What ligament forms as the quadrates lumborum fascia thickens?
Lateral Arcuate Ligament
169
What forms the lateral border of the rectus abdominis m?
Linea Semilunaris
170
What kind of Vagotomy would you do to denervate only the stomach?
Proximal Gastric Vagotomy
171
Where does the Lesser Splanchnic Nerve synapse?
Superior Mesenteric Ganglion
172
A patient has developed gallstones from their inflamed gallbladder. What do you think was the target of the initial bacterial accumulation?
Rokitansky-Aschoff Sinuses
173
Where do the guts end up in a reverse (180 deg) gut rotation?
Transverse colon is behind the duodenum
174
What determines the length of of a slow wave contraction?
Number of action potentials (more means longer)
175
What physical finding can you palpate in the case of a leaking aortic aneurism?
Its impulse in the epigastrium
176
What ligament forms the epiploic foramen?
Hepato-Duodenal Ligament
177
What explains why the parasympathetic nervous system doesn't see the same mass activation as the sympathetic?
Lack of Extensive Divergence in preganglionic axons
178
What ligament are the right and left gastric arteries associated with?
Hepatogastric L
179
What does NE do to slow waves?
Decreases the Amplitude
180
What diaphragmatic ligament unites the left and right crura?
Median Arcuate l. Crossing the Aorta
181
What is the hallmark of Chief Cells?
Lots of RER and Apical Secretory Granules (zymogen)
182
What exits through the superficial ring?
Spermatic cord or round ligament
183
Where in Hasselbach's (inguinal) triangle would you get a direct hernia?
Medial to the inferior epigastric a.
184
What does the Superficial Circumflex iliac artery come off?
Femoral A
185
What glands would you find deep to the submucosa in the duodenum, and what do they do?
Brunners Glands that neutralize the acidic Chyme
186
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
187
Something relaxes and something contracts in the rectosphincteric reflex. "Butt" what?
Smooth muscle wall of rectum contracts
| Internal anal sphincter relaxes
188
What ligament is a continuation of fibers from the lacunar ligament, running along the pectin pubis?
Pectineal Ligament
189
What plane does the Iliocecal junction lie in?
Transtubercle Plane
190
What is the major difference between gastroschiscis and omhalocele?
Gastroschiscis has no peritoneal covering!
191
What is the Embryonic tissue consolidates in the dorsal mesogastrium to form the spleen?
Mesenchyme (derived from mesoderm)
192
Decreased number of ganglion cells and inhibitory (NO / VIP) ganglions and damage to esophagus nerves can result in what condition?
Achalasia
193
What V/A pair is behind the tail of the pancreas?
Splenic A/V
194
What innervates the adrenal gland?
Celiac Plexus
| Abdominopelvic Splanchnic nerves
195
What accumulates in a hydrocele, and within what structure?
Peritoneal Fluid accumulation in the Tunica Vaginalis
196
What nervous GI component is found beneath the tenea coli?
ENS / Myenteric Plexus
197
What organs are responsible for pain in the epigastric region?
Foregut (stomach, duodenum, biliary tract)
198
Where do the lumbar arteries come off?
Abdominal Aorta
199
What innervates the external anal sphincter?
Somatic Pudendal Nerves
200
What is the rectus abdominis in contact with below the arcuate line?
Transversalis Fascia
201
What does the Myenteric Plexus (Auerbach's) control?
GI Movements
202
What is the target of the T1 - T4 post-ganglionic sympathetic nerve pathway?
Up a Level to the Salivary Gland, etc
203
What are the respective blood supplies to the developing foregut, midgut, and hindgut?
Foregut: Celiac Trunk
Midgut: SMA
Hindgut: IMA
204
What area of the abdomen will be tender in the case of a leaking aortic aneurism?
Epigastrium
205
What innervates the appendix?
Subcostal N (T12)
206
What fascia is fused with the fascia lata of the lower limb?
Scarpas (makes it so fluid cant pass from abdomen to leg)
207
What vertebral level is the sigmoid / rectum junction?
S3
208
What are the greater vs lesser omentum embryonic derivatives?
Greater Omentum: Dorsal Mesentery
| Lesser Omentum: Ventral Mesentery
209
What hernia originates from a weakness in the wall at the midline fusion point?
Epigastric
210
What liver fissure contains the gall bladder and IVC?
Right Sagittal Fissure
211
Where is peritonitis localized to in a pt with a ruptured ectopic pregnancy?
Suprapubic (hypogastric) area
212
What do the rami communicates connect?
Spinal nerves (white T1 - L2 only) to the sympathetic trunk
213
What does the gubernaculum connect?
Gonads to future scrotal swellings
214
What is contained within the appendix to give it function?
Lymphoid Nodules
215
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
216
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
217
What is the root of the subcostal nerve?
T12
218
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
219
Which Omentum is attached to the duodenum, transverse colon and stomach?
Greater
220
What does the Inguinal Ligament attach to?
ASIS and Pubic Tubercle
221
What has to rupture to allow the Urogenital sinus and anal canal to be open to the exterior?
Cloacal Membrane
222
What 4 hormones "tend to stimulate contractions"?
Gastrin
CCK
Motilin
Insulin
223
What artery is the root of the mesentery associated with?
ileocolic a.
224
What type of fibers dominate the stomach mucosa?
Reticular and Collagen
225
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)
```
226
What two parts of the Liver's visceral surface are not covered with peritoneum?
At the gall bladder and Porta Hepatis
227
What is the lowest derivative of the foregut?
Upper Duodenum
228
What parts of the GI tract does the Vagus nerve give parasympathetics to?
Cecum, Ascending and Transverse Colon
229
What does having a hairy chest reduce your chances of?
Cerrhosis
230
Where are the majority of Hirschprung resections?
Short Segment in rectosigmoid region
231
What are the 4 Secondarily retroperitoneal viscera?
Duodenum
Pancreas
Ascending and descending colon
232
What joints the Aorta at its diaphragmatic opening at T12?
Thoracic Duct
| sometimes azygous and hemiazygous
233
What creates the arrangement of different cells around the sinusoids of adjacent liver lobules?
[O2] gradient created by arterial blood flow
234
Where would you find Microfold Cells?
Ileal Mucosa, atop Peyers Patches
235
What two structures come together to form the Hepatopancreatic Ampulla (of oddi)?
Bile Duct (of the gallbladder) and Main Pancreatic Duct
236
Hepatocytes are arranged into plates, supported by reticular fibers, and separated by sinusoids. What are these plates arranged around?
Central Vein
237
What does the inferior epigastric a anastamose with?
Superior Epigastric a.
238
Hepatocytes are arranged in cords within the liver. what do they secrete?
Bile
239
A patient has cramp-like (colicky) pain. What type of thing does this come from?
Obstructions of hollow muscular viscus (bowel, ureter)
240
Passing a kidney stone hurts like hell. Where would a patient have pain that leads you to suspect it as a diagnosis?
Back
241
What 3 things do the Lesser Splanchnic Nerve Supply?
Jejunum and Ilium
Cecum
Ascending and Transverse Colon
242
What are all the lymphatics of the posterior abdominal wall collected into?
Cisterni chyli
243
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)
244
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
245
How does the Entero-Gastric Reflex inhibit gastric emptying in response to fats in the duodenum?
CCK and GIP are released, directly inhibiting motility.
246
What do the descending and sigmoid colon and rectum get their parasympathetics from?
Pelvic nerves S2-S4
247
Which liver fissure contains the ligamentum teres?
Left Sagittal fissure
248
What is the root of the ilioinguinal n..
L1
249
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
250
Which kind of peristaltic wave can occur after Vagotomy?
Secondary (also controlled by ENS, not just medulla)
251
What does the internal vs external spermatic facia come from?
Internal is from the Transversalis fascia
| External is from the External Oblique
252
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
253
What two landmarks would you find at the superior constrictor?
Cricoid cartilage, pharynx
254
What does the genitofemoral n. supply?
Motor to Cremaster
| Sensory to medial thigh and scrotum / Labia
255
What plane do you find at the 8th rib / L1?
Transpyloric Plane
256
What type of incision do you associate with McBurneys point (appendectomy)?
Gridline
257
What do the apical surface receptors of M cells bind?
Gram Negative Bacteria (E Coli) and Certain Macromolecules
258
Where would you expect to find cardiac esophageal glands?
Lamina propria of Terminal Esophagus (protective)
259
What are the arteries (and their branches) that supply the jejunum?
Arcades and their branches (vasa rectae)
260
What is the origin of the Vagus nerve?
Dorsal Motor Nucleus (medulla)
261
You can have low, intermediate, and high Imperforated Anus. Where is the Distinction?
Relative to the Levator Ani and pelvic bony landmarks
262
What does ACh do to slow waves?
Increases the Amplitude
263
What part of the mucosa can you find the muscular mucosae of the esophagus?
Lower segment only
264
What are the two targets of the spinal nerve pathway (sympathetic)?
Blood Vessels
| Arrector Pili
265
What structures do ducts use to propel products?
Myoepithelial cells
266
What does the gastro-enteric (gastro-ileal) reflex do?
gastric distention relaxes ileocecal sphincter
267
Where in the inguinal / hasselbach's triangle would you get a femoral hernia?
Below the inguinal ligament
268
How do you get Barretts Esophagus?
GERD
269
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.
270
What three structures grow into the Ventral Mesentery for pancreas formation?
Cystic Diverticulum
Ventral Pancreatic Bud
Endodermal Bud
271
What does the Migrating Motor Complex do?
Empties large particles of undigested reside
272
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
273
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
274
What abdominal ligament would you associate with high speed collisions?
Suspensory Ligament of Duodenum (Treitz)
275
What abdominal complaint is suggested by previous history of surgery?
Adhesive small bowel obstruction
276
What happens in the absence of the MMC?
Small Intestinal Bacterial Overgrowth (colon bacteria in the small intestine)
277
Sx: Neonatal jaundice, white clay colored stools, dark urine. Whats the Disease and treatment?
Biliary Atresia
| Liver Transplant
278
What is the origin of the iliopubic tract?
thickened Transversalis Fascia on the floor of the inguinal canal
279
What ligament forms as the psoas fascia thickens?
Medial Arcuate L.
280
Which branch of the external iliac a. runs deep along the inguinal ligament?
Deep Circumflex Iliac a.
281
What innervates the Transversus Abdominis m?
T7 - L1
282
Zymogen granules contain digestive enzymes. What type of cell would you expect to see them in?
Pancreatic Acinar Cells
283
What proteins do we associate with parasympathetic gut action?
Gastrin
| Motilin
284
What are the three constriction sites of the ureter?
Its junction with the Renal Pelvis
Crossing the Pelvic Brim
Entering the Bladder Wall
285
Besides injury to the Vagus nerve, what disease can cause Gastroparesis?
DM 1
286
What do Lesser Splanchnic Nerve postganglionic fibers travel with?
Branches of the SMA
287
Where does the duodenal obstruction or stenosis have to happen to give a paten bilious vomiting with their annular pancreas?
Inferior to bile duct
288
Where do the midgut derivatives start and end?
Starts at the lower duodenum
| Ends at the proximal 2/3 of the transverse colon
289
What do M Cells Do?
Antigen Transport
290
What four things do you associate with enteroendocrine cell release?
Gastrin
Secretin
GIP
CCK
291
What separates the right and left liver?
Cantlie Line
292
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
293
Where do Splanchnic nerves terminate?
Pre-Vertebral Ganglia
294
Where would you find the Myenteric Plexus of Auerbach?
Between the Inner Circular and Outer Longitudinal layers of Muscularis
295
Where does the greater splanchnic nerve synapse?
celiac ganglion
296
What segments are in the left liver?
I - IV
297
What week is bile formed by the hepatic cells?
Week 12 on
298
What is the main histological differences within the gallbladder, and where are they?
Against the Liver: External Adventita
| Exposed to Peritoneal Cavity: Serosa
299
What roots are the 3rd and 4th Lumbar Splanchnic nerves associated with?
3rd: L3
4th: L4 and L5
300
What organs are responsible for pain (initially) in the suprapubic or hypogastric areas?
Hindgut organs (most of colon, half of sigmoid)
301
What kind of epithelium is found in the striated duct of the salivary gland?
Simple Cuboidal-to-Columnar
302
Where do the hindgut derivatives start?
Distal 1/3 of the transverse colon
303
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
304
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
305
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
306
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.
307
What do the bile canaliculi drain into?
Canals of Hering
308
What is the ratio of oxygen/nutrients by zone in the hepatic acinus?
Zone 1: High [o2 / nutrients]
| Zone 3: Low [o2 / nutrients}
309
What plane does the transverse colon lie in?
Subcostal Plane
310
What is the functional unit of the Exocrine pancreas?
Serous Acinus
311
What is the root of the iliohypogastric n?
L1
312
What is the fate of the processus vaginalis?
Becomes Tunica Vaginalis
313
What lobes does the porta hepatis separate?
Caudate and Quadrate
314
The embryonic derivatives of the anal canal is divided into thirds. What are they?
Top 2/3 is endoderm
| Lower 1/3 is ectoderm
315
What does somatic pain come from?
Parietal Peritoneum irritation because the diseased organ is creating friction
316
What is the embryological origin of the medial umbilical fold?
Obliterated Umbilical Arteries
317
What ligaments are made by the external oblique?
Inguinal Ligament
Lacunar Ligament
Opening of superficial inguinal ring
318
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
319
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
320
What is the hallmark of Colon histology?
Simple Columnar glands with lots and lots of Goblet Cels
321
What do the sacral Splanchnic Nerves ride to get to the pelvic visceral and perineum?
Internal Iliac Artery
322
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
323
Which segments are in the Right Liver?
V - VIII
324
What two conditions can create a secondary peristaltic wave?
Primary wave fails to empty the esophagus
| Gastic contents reflux into the esophagus
325
Which type of pain can be localized to its corresponding dermatome?
Parietal
326
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
327
What three GI elements does the splanchnic mesoderm form?
Muscular wall
Vascular Elements
Connective Tissue Elements
328
What modulates the MMC?
Motilin
329
What innervates the external oblique?
Ventral rami of T7 - 12 intercostal n.
330
What Arteries can you find on the superior side of the diaphragm?
```
Musculophrenic and pericardiacophrenic (off int thor)
Superior Phrenic (off thoracic aorta)
```
331
What plane does the appendix and sigmoid colon lie in?
Interspinous Plane
332
What three ganglia are considered pre-vertebral?
Celiac and the mesenteries
333
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.
334
What is the role of cells that distinguish the hepatic sinusoids?
Phagocytosis (they're stellate macrophages)
| This is Kupffer cells
335
What fold would you associate with the supravesicular fossa?
Median Umbilical Fold
336
What happens with the obliques and transversus abdominis at the arcuate line?
They all become anterior to the rectus abdominis
