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GIGU > Quiz 1 > Flashcards

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

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2
Q

Where do the Four Lumbar Splanchnic Nerves Synapse?

A

Intermesenteric Plexus

Anterior Aorta, between SMA and IMA

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3
Q

The greater omentum really forms during stomach rotation. What structure enlarges to create it?

A

Dorsal Mesogastrum

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4
Q

How does the Lateral Umbilical fold come about?

A

Due to Inferior Epigastric A

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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

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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

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7
Q

The Abdominal Aortic Plexus controls digestion. what three plexuses does it consist of?

A

Celiac
Superior Mesenteric
Inferior Mesenteric

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8
Q

What vertebral levels are the left and right stomach fixed to?

A

L: T10 - 11
R: L1

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9
Q

What spinal cord levels are the first and second lumbar splanchnic nerves associated with?

A

L1 and L2

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10
Q

Mass activation of sympathetic ganglia cause a heightened sense of stimulation due to stimulation of what?

A

RAS

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11
Q

If you sever the Gastrophrenic L, what blood vessel might you expect to be severed with it?

A

Posterior Gastric A

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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

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13
Q

What is the embryonic derivative of enteric ganglia/nerves and their glia?

A

Nerves: Ectoderm
Glia: NCCs

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14
Q

What lines the bile canaliculus?

A

Cholangiocytes (between adjacent hepatocytes)

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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

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16
Q

What two things does the peritoneum product to fight infection?

A

Antibodies

Leukocytes

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17
Q

How does the Entero-Gastric Reflex inhibit gastric emptying in response to hypertonicity in the duodenum?

A

nobody knows

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18
Q

A patient has a positive murphys sign and a painful right shoulder. What do you think it is?

A

Actue Cholecystitis

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19
Q

What stimulates the chemical trigger zone of the vomiting reflex?

A

Apomorphine, Morphine

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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)

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21
Q

What two paths do Visceral Autonomic Efferents use?

A

Vagus or Pelvic Splanchnics

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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

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23
Q

What landmarks do you identify to form portal lobules, destined to drain into the same bile duct?

A

3 Central Veins

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24
Q

What sandwiches the lesser peritoneal sac?

A

Omentum

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25
Q

What is the nerve root for the sympathetic innervation to the gut?

A

T10 - L2

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26
Q

What lobes does the Falciform Ligament Separate?

A

Left Lobe and Right Lobe

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27
Q

What is the embryological origin of the median umbilical fold?

A

Obliterated Urachus (which used to be the allantois)

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28
Q

What muscle does the rectus abdominis m. form?

A

Pyramidis m. (missing in 20% of people)

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29
Q

What two arteries is the Gastrocolic l. associated with?

A

R and L Gastroepiploic a.

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30
Q

What two signs would you look for to differentiate obstructing cancer of the descending colon?

A

Older Age pt

Possible mass to feel in the LLQ

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31
Q

What creates the cooling blood countercurrent for the testicles?

A

Pampiniform Plexus

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32
Q

What 5 things does the posterior vagal trunk distribute to?

A 
Pancreas
Liver
Biliary System
Small Intestine
Proximal Large Intestine (including transverse colon)
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33
Q

What lymph nodes do the testes drain into?

A

Lumbar and Pre-Aortic lymph nodes

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34
Q

What do the Canals of Hering Drain into, and what is their fate?

A

Bile Ductules that merge and enlarge to drain into the L and R Hepatic Ductsq

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35
Q

The Mucosal GI Tract’s lamina propria is rich in life. What kind of things can you expect to find there?

A

Immune stuff (Nodules, Lymphocytes, Macrophages, Plasma cells)

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36
Q

What do the 3rd and 4th lumbar splanchnic nerves travel on to get to the Superior Hypogastric Plexus?

A

Distal Aorta (to the superior hypogastric plexus)

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37
Q

Where do Sacral Splanchnic Nerves Synapse?

A

Inferior Hypogastric Plexus

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38
Q

What The scrotum eventually drains into the iliac and lumbar lymph nodes. What does it pass through first to get there?

A

Superficial Inguinal Nodes

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39
Q

What are the 4 unpaired arteries of the posterior abdominal wall?

A

Celiac Trunk
Superior / Inferior Mesenteric As
Median Sacral A

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40
Q

What plexus do the 3rd and 4th lumbar splanchnic nerves synapse on?

A

Superior Hypogastric Plexus (or through to the ureter)

Inferior Hypogastric Plexus on anterior sacrum

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41
Q

When would you consider abdominal pain chronic?

A

After Three weeks. Before that, its acute or sub-acute

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42
Q

Where is Meissners Plexus?

A

Submucosa

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43
Q

What kind of pain do you observe in someone with tenderness and guarding?

A

Parietal

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44
Q

What would blood fail to reach if there was a problem with the potential space of Disse Nuts?

A

Hepatocytes

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45
Q

What glands are found in the stomach mucosa lamina propria?

A

Cardiac, gastric, pyloric

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46
Q

What proteins do we associate with sympathetic gut action?

A

Secretin

GIP

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47
Q

What do Greater Splanchnic Nerve postganglionic fibers travel with?

A

Branches of Celiac Trunk

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48
Q

What does CCK do to the stomach?

A

Increases distensibility

Decreases Contractions

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49
Q

What direction do gray rami communicates carry information vs white rami communicates?

A

White: Spinal nerve to Sympathetic Trunk
Grey: Sympathetic Trunk to Spinal Nerves

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50
Q

What are the three hallmarks of the parotid gland?

A

CN VII passes through it
Its is or is in Adipose tissue
Serous Only

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51
Q

What do the Interstitial cells of Cajal do?

A

Pacemaker for the GI tract (generate and propagate!)

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52
Q

What does the Vagovagal reflex do to the stomach?

A

Expands the Volume of the rOad Region

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53
Q

What ligament anchors the inguinal ligament to the pubis?

A

Lacunar L.

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54
Q

What three things can you find in the infra-colic compartment of the peritoneal cavity?

A

Small intestine

Ascending Colon and Descending colon

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55
Q

What is the origin and insertion of the internal oblique muscle?

A

Iliac Crest to ribs 10-12, linea alba, pubic crest

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56
Q

What gland is made from pyramidal cells?

A

Parotid gland

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57
Q

What propels the poop into the rectum to stimulate the defecation reflex?

A

Mass Movements

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58
Q

Where do the guts end up with non-rotation of the midgut loop?

A

Left Sided Colon

Right Sided Small Intestine

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59
Q

What is the common embryonic origin of the mesocolons, mesoappendix, and small intestine mesentery?

A

The Dorsal Mesentery

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60
Q

Where would you find a spigelian hernia?

A

Along the semilunar line of rectus abdominis

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61
Q

What type of hernias do the inguinal triangle get?

A

Direct

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62
Q

What separates the esophagus from the funds of the stomach?

A

Cardiac Notch

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63
Q

What part of the GI tract is the mesentery attached to?

A

Jejunum and Ilium (and posterior abdominal wall)

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64
Q

What arteries can you find o the inferior side of the diaphragm?

A 
Inferior Phrenic (off abdominal aorta)
Intercostal Branches (for the periphery)
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65
Q

What landmark would you find at the inferior constrictor?

A

Diaphragmatic Sphincter

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66
Q

What is the etiology of Biliary Atresia?

A

Obliteration of extra-hepatic and/or intra-hepatic ducts, replaced by fibrosis

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67
Q

What is the origin and insertion of the external oblique?

A

Lower 6 ribs to the linea alba, anterior iliac crest, pubic tubercle

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68
Q

Which Peritoneal division contains the stomach, liver, and spleen?

A

Supracolic

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69
Q

A patent has a palpable mass, or olive, at the right costal margin. what do you think is the embryonic origin of this disease?

A

Faulty migration of neural crest cells, therefore improper ganglion cell population
This is hypertrophic pyloric stenosis

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70
Q

What do Least Splanchnic Nerve postganglionic fibers travel with?

A

Renal Arteries

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71
Q

You see circular chunks in an oblique section of the GI tract. What do you think?

A

Cardiac Glands

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72
Q

What plexus controls the GI secretions and local blood flow?

A

Submucosal Plexus

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73
Q

What are the roots of the pelvic splanchnic nerves?

A

S2 - S4

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74
Q

Circular and longitudinal muscles are reciprocally innervate to oppose and compliment each others actions. What does this result in?

A

Peristaltic Contractions

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75
Q

What muscle lies directly posterior to the larges part of the kidney?

A

Quadratus lumborum

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76
Q

What incision is most typical for Ob/Gyn surgeries?

A

Suprapubic

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77
Q

What branch of the external iliac a. runs posterior to the rectus abdominis?

A

Inferior Epigastric a.

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78
Q

What do we need to trigger contractions in the small intestine if slow waves aren’t enough?

A

Spike Potentials. However - Slow wave frequency sets the maximum contraction frequency.

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79
Q

What reflex initiates mass movements and transmits via the ANS?

A

Gastro-colic and Duodeno-colic reflexes

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80
Q

What roots are the Sacral Splanchnic Nerves Associated with?

A

S1 to S5

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81
Q

Which type of liver lobule is associated with which function?

A

Classic: Endocrine
Portal: Exocrine

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82
Q

What innervates the internal oblique muscle?

A

T7-12 and L1

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83
Q

What vessels are directly anterior to the ureter?

A

Ductus deferens or Uterine Artery

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84
Q

Why does regurgitation of stomach contents happen in sliding hiatal hernias and not para esophageal hiatal hernias?

A

Its all about where the cardiac portion of the stomach is. Its normal in para-esophageal, but herniated in sliding hiatal hernias.

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85
Q

What is the relationship between gastric emptying and tone of the pylorus?

A

Inverse

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86
Q

What congenital anomaly can become inflamed and mimic acute appendicitis?

A

Ileal (Meckel’s) Diverticulum

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87
Q

Where does the Anterior Vagal Trunk Synapse?

A

Enteric Plexus (in stomach) to supply glands and smooth muscle

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88
Q

What artery is the terminal branch of the internal thoracic a?

A

Superior Epigastric a.

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89
Q

What kind of Vagotomy would you do to denervate only the Parietal cells of the stomach?

A

Selective Proximal Vagotomy

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90
Q

You can get megacolon from Hirschsprung disease. What is the embryonic origin of this disease?

A

Failure of NCCs to migrate and create ganglionic plexus, which also leads to hypertrophy in the segment.

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91
Q

How does a volvulus of the sigmoid colon occur?

A

Twisting of its mobile loop, obstructing it

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92
Q

Where might you find meconium with defects of the urorectal septum?

A

Rectovaginal: Vagina

Rectovesical/urethral: Urine

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93
Q

Where is the thoracic pain line?

A

Plane of sternal angle, T4 - T5

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94
Q

What do zymogen granules of Chief Cells store?

A

Pepsionigen (for conversion to pepsin)

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95
Q

What do the 3rd and 4th lumbar Splanchnic nerves travel on after synapsing in the Inferior Hypogastric Plexus?

A

Branches of Internal Iliac Artery (to get to the pelvic viscera and perineum)

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96
Q

What is the relationship between gastric emptying and segmentation of contractions in the intestine?

A

Inverse

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97
Q

Which Omentum is attached to the duodenum, liver, and stomach?

A

Lesser

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98
Q

A cell stores vitamin A. What do you think it is?

A

Hepatic Stellate Cell / Ito Cell

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99
Q

What structure is blocked, causing obstructive jaundice?

A

Common Bile Duct

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100
Q

What does the superficial epigastric artery come off?

A

Femoral A

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101
Q

What two arteries does the External Iliac A give off in the abdominal wall?

A

Deep Circumflex Iliac

Inferior Epigastric

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102
Q

What tendon does the internal oblique muscle make?

A

(part of the) Conjoint Tendon / Inguinal Falx with transversus abdominis m. contributing the rest

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103
Q

What quadrant holds the Ilium?

A

RLQ

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104
Q

What kind of epithelium is found in the intercalated duct of the salivary gland?

A

Low Cuboidal

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105
Q

What is the target of the T10 - L2 Splanchnic Nerve Pathway?

A

Down a Level to the Bladder, etc

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106
Q

What part of the GI tract first introduces Plicae?

A

Jejunum

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107
Q

GI Sympathetics come from lateral horn nerves and Thoracic Splanchnic Nerves. What are the roots of these?

A

Lateral Horn: T1 - L2

Splanchnic: T5 - L2

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108
Q

How does the Entero-Gastric Reflex inhibit gastric emptying in response to acid in the duodenum?

A

Secretin is released, which uses Gastrin to inhibit motility

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109
Q

What innervates the Rectus Abdominis m.?

A

T7-12 ventral rami

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110
Q

What is the main difference between slow waves in the stomach vs in the small intestine?

A

In the small intestine, they do not directly initiate contractions. They are always present regardless.

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111
Q

SADPUCKR is the acronym for retroperotineal organs. What does this stand for?

A

Suprarenal glands, Aorta/IVC, Duodenum (234), Pancreas(not tail), Ureters, Colon(a/d), Kidneys, Esophagus, rectum.

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112
Q

a pt has a connection between the tunica vaginalis and abdomen. What do we call this?

A

Persistent Processus Vaginalis

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113
Q

Where would the sudden onset of pain be in a pt with a ruptured ectopic pregnancy?

A

Hypogastrium radiating to sacrum

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114
Q

What are the two retroperitoneal viscera?

A

Thoracic Esophagus and Rectum

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115
Q

What are the two key characteristics of the Jejunum?

A

Villi and a lack of Submucosal Glands

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116
Q

Where do you find serosa vs adventitia along the GI tract?

A

Thoracic Esophagus is Adventitia

Inferior to Diaphragm is Serosa

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117
Q

What is the epithelium and core of intestinal Villi made from?

A

Epithelium is simple columnar with Enterocytes and Goblet

Core is Loose CT with vasculature and a Lacteal

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118
Q

What gland would you identify as having Serous Demilunes?

A

Submandibular Gland

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119
Q

We all know that I ate ten eggs at 12. What did I have with the eggs?

A

Left and Right Vagal Trunks

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120
Q

What two changes occur from the second, 180 degree, CCW rotation of the gut?

A

Cecum is brought to RUQ, for now.

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121
Q

What muscle creates the cremaster m.?

A

Internal Oblique

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122
Q

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?

A

Iliohypogastric does UPPER inguinal and hypogastric region

Ilioinguinal does LOWER inguinal, anterior scrotum/labia, and the near medial thigh.

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123
Q

What fascia is the scarpas fascia continuous with?

A

Colle’s Fascia (allows fluid to move in and out of superficial perineum)

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124
Q

What three things are in the female inguinal canal?

A

Round Ligament of the Uterus
Ilioinguinal Nerve
Genitofemoral nerve (genital branch)

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125
Q

What kind of epithelium is found in the excretory duct of the salivary gland?

A

Simple cuboidal-to-Pseudostratified Columnar

OR Stratified Cuboidal

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126
Q

What three layers of the abdominal wall are carried with the developing spermatic cord?

A

Transversalis Fascia
Internal Oblique
External Oblique

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127
Q

What 2 hormones “tend to inhibit contractions”?

A

Secretin and Glucagon

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128
Q

What 2 things do the least splanchnic nerve supply?

A

Kidneys and Adrenals

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129
Q

What fold would you associate the lateral inguinal fossa with?

A

Lateral Umbilical fold

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130
Q

What three things do the pelvic splanchnic nerves supply?

A

Descending colon to the anal canal
Urogenital Organs
Perineum organs

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131
Q

Which kinds of axons from the sympathetic and parasympathetic increase and decrease motility in the GI tract?

A

Preganglionic Increase Motility (parasympathetic)

Postganglionic Decrease Motility (sympathetic)

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132
Q

Cryptorchid Testes means they remain undescended. What does this worry us about down the road?

A

Testicular Cancer

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133
Q

What is the hallmark of Large Intestine Histology?

A

Crypts of Lieberkühn, Glands, goblet cells

NO villi

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134
Q

What vasculature supplies the rectum (endoderm) vs the anus (ectoderm)?

A

Rectum: Superior and middle rectal A/V of hindgut
Anus: Inferior Rectal A/V

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135
Q

We all know that I ate ten eggs at 12. What else ate ten eggs at 12?

A

Right Phrenic Nerve

136
Q

Where does the Least Splanchnic Nerve Synapse?

A

Aorticorenal Ganglion

137
Q

The urorectal septum forms what you’d expect - the dorsal anorectal canal and ventral urogenital sinus. What is is partitioning to make these structures?

A

Cloaca

138
Q

What are the two components of the lesser omentum?

A

Hepato-duodenal Ligament

Hepato-gastric Ligament

139
Q

What two landmarks would you find at the middle constrictor?

A

Aorta, Left main bronchi

140
Q

Meckels diverticulum causes abdominal swelling, intestinal abstraction, and bowel sepsis. How does it happen?

A

The Yolk Stalk (vitelline duct) connection to the midgut regresses

141
Q

What are patients with a pancreas divisor more prone to?

A

Pancreatitis

142
Q

What fold would you associate with the medial umbilical fossa?

A

Medial Umbilical Fold

143
Q

What Quadrant holds the Jejunum

A

LUQ

144
Q

Hirschpring’s Disease, or “achalasia of the ass”, sees absent ganglion cells and low VIP. How would you treat it?

A

Surgical Resection of the colon segment lacking ganglia and, presumably, filled with poo.

145
Q

What is the root of the thoracoabdominal nerve?

A

T7-11

146
Q

What is the role of the muscular mucosase?

A

Controls the mobility of mucosa / mucosal glands

147
Q

The three ligaments of the liver share the same structural embryonic origin. What is it?

A

Ventral Mesentery

148
Q

What is the target of the T5 - L2 Splanchnic Nerve Pathway?

A

Same Level to the Small Intestine, etc

149
Q

What two plexuses control the urinary and reproductive functions (by innervating the pelvic viscera)?

A

Superior and Inferior Hypogastric Plexuses

150
Q

What organs are responsible for periumbilical pain?

A

Midgut organs (small bowel, appendix, cecum)

151
Q

What spinal cord levels does the adrenal medulla pathway arise from?

A

T8 - L1

152
Q

What is a volvulus?

A

Rolled up and twisted intestines

153
Q

What is the most superficial layer of the GI tract?

A

Serosa / Adventitia

154
Q

What do the peritoneal sacs use to communicate?

A

the Epiploic Foramen

155
Q

What two things do Paneth cells release to do antimicrobial action?

A

Lysozyme

a-Defensins

156
Q

What comes together to form the Hepatopancreatic Ampulla?

A

Common Bile Duct

Main Pancreatic Duct

157
Q

If the Superior mesenteric plexus does sympathetic innervation to Proximal regions and the Inferior does Distal regions, what does the Hypogastric Plexus do?

A

Distal Rectum and Anal Canal

158
Q

What does the Gubernaculum become?

A

Ovarian Ligament and Round Ligament of the uterus

159
Q

What is the origin of the Round Ligament?

A

Obliterated Umbilical Vein

160
Q

What three structures refer pain to the back?

A

The Retroperitoneal ones: Pancreas, Kidney, Aorta

161
Q

The gut lumen is temporarily obliterated to accommodate the endodermal proliferation. What disease is linked with its failure to recanalize?

A

Trisomy 21

162
Q

What is the root of the genitofemoral n.?

A

L1 and L2

163
Q

What is the order of duct structures that substances pass through?

A

Acinus, Intercalated duct, Striated duct, excretory duct

164
Q

What do the testes descend through, into the future scrotum?

A

Processus Vaginalis (outpocket of peritoneal cavity)

165
Q

Where do the common iliac lymph nodes drain into?

A

Lumbar Lymph nodes

166
Q

What type of hernia would you associate with the deep inguinal ring?

A

Indirect

167
Q

What does the round ligament attach to during ovarian descent?

A

Labial swellings

168
Q

What ligament forms as the quadrates lumborum fascia thickens?

A

Lateral Arcuate Ligament

169
Q

What forms the lateral border of the rectus abdominis m?

A

Linea Semilunaris

170
Q

What kind of Vagotomy would you do to denervate only the stomach?

A

Proximal Gastric Vagotomy

171
Q

Where does the Lesser Splanchnic Nerve synapse?

A

Superior Mesenteric Ganglion

172
Q

A patient has developed gallstones from their inflamed gallbladder. What do you think was the target of the initial bacterial accumulation?

A

Rokitansky-Aschoff Sinuses

173
Q

Where do the guts end up in a reverse (180 deg) gut rotation?

A

Transverse colon is behind the duodenum

174
Q

What determines the length of of a slow wave contraction?

A

Number of action potentials (more means longer)

175
Q

What physical finding can you palpate in the case of a leaking aortic aneurism?

A

Its impulse in the epigastrium

176
Q

What ligament forms the epiploic foramen?

A

Hepato-Duodenal Ligament

177
Q

What explains why the parasympathetic nervous system doesn’t see the same mass activation as the sympathetic?

A

Lack of Extensive Divergence in preganglionic axons

178
Q

What ligament are the right and left gastric arteries associated with?

A

Hepatogastric L

179
Q

What does NE do to slow waves?

A

Decreases the Amplitude

180
Q

What diaphragmatic ligament unites the left and right crura?

A

Median Arcuate l. Crossing the Aorta

181
Q

What is the hallmark of Chief Cells?

A

Lots of RER and Apical Secretory Granules (zymogen)

182
Q

What exits through the superficial ring?

A

Spermatic cord or round ligament

183
Q

Where in Hasselbach’s (inguinal) triangle would you get a direct hernia?

A

Medial to the inferior epigastric a.

184
Q

What does the Superficial Circumflex iliac artery come off?

A

Femoral A

185
Q

What glands would you find deep to the submucosa in the duodenum, and what do they do?

A

Brunners Glands that neutralize the acidic Chyme

186
Q

We all know that chronic GERD causes Barrett’s esophagus, but how would we know it when we see it?

A

Non-Keratinized Stratified Squamous in the Transition Zone (from esophagus to stomach) becomes Columnar and Glandular

187
Q

Something relaxes and something contracts in the rectosphincteric reflex. “Butt” what?

A

Smooth muscle wall of rectum contracts

Internal anal sphincter relaxes

188
Q

What ligament is a continuation of fibers from the lacunar ligament, running along the pectin pubis?

A

Pectineal Ligament

189
Q

What plane does the Iliocecal junction lie in?

A

Transtubercle Plane

190
Q

What is the major difference between gastroschiscis and omhalocele?

A

Gastroschiscis has no peritoneal covering!

191
Q

What is the Embryonic tissue consolidates in the dorsal mesogastrium to form the spleen?

A

Mesenchyme (derived from mesoderm)

192
Q

Decreased number of ganglion cells and inhibitory (NO / VIP) ganglions and damage to esophagus nerves can result in what condition?

A

Achalasia

193
Q

What V/A pair is behind the tail of the pancreas?

A

Splenic A/V

194
Q

What innervates the adrenal gland?

A

Celiac Plexus

Abdominopelvic Splanchnic nerves

195
Q

What accumulates in a hydrocele, and within what structure?

A

Peritoneal Fluid accumulation in the Tunica Vaginalis

196
Q

What nervous GI component is found beneath the tenea coli?

A

ENS / Myenteric Plexus

197
Q

What organs are responsible for pain in the epigastric region?

A

Foregut (stomach, duodenum, biliary tract)

198
Q

Where do the lumbar arteries come off?

A

Abdominal Aorta

199
Q

What innervates the external anal sphincter?

A

Somatic Pudendal Nerves

200
Q

What is the rectus abdominis in contact with below the arcuate line?

A

Transversalis Fascia

201
Q

What does the Myenteric Plexus (Auerbach’s) control?

A

GI Movements

202
Q

What is the target of the T1 - T4 post-ganglionic sympathetic nerve pathway?

A

Up a Level to the Salivary Gland, etc

203
Q

What are the respective blood supplies to the developing foregut, midgut, and hindgut?

A

Foregut: Celiac Trunk
Midgut: SMA
Hindgut: IMA

204
Q

What area of the abdomen will be tender in the case of a leaking aortic aneurism?

A

Epigastrium

205
Q

What innervates the appendix?

A

Subcostal N (T12)

206
Q

What fascia is fused with the fascia lata of the lower limb?

A

Scarpas (makes it so fluid cant pass from abdomen to leg)

207
Q

What vertebral level is the sigmoid / rectum junction?

A

S3

208
Q

What are the greater vs lesser omentum embryonic derivatives?

A

Greater Omentum: Dorsal Mesentery

Lesser Omentum: Ventral Mesentery

209
Q

What hernia originates from a weakness in the wall at the midline fusion point?

A

Epigastric

210
Q

What liver fissure contains the gall bladder and IVC?

A

Right Sagittal Fissure

211
Q

Where is peritonitis localized to in a pt with a ruptured ectopic pregnancy?

A

Suprapubic (hypogastric) area

212
Q

What do the rami communicates connect?

A

Spinal nerves (white T1 - L2 only) to the sympathetic trunk

213
Q

What does the gubernaculum connect?

A

Gonads to future scrotal swellings

214
Q

What is contained within the appendix to give it function?

A

Lymphoid Nodules

215
Q

What is the protective type of mucosa in the GI tract, and where is it found?

A

Nonkeratinized Strat Squam

in the mouth, pharynx, and anus

216
Q

The liver starts as a diverticulum, and then forms its components from both endoderm and splanchnic mesoderm. What are the endoderm parts?

A

Hepatocytes
Bile Ducts
Hepatic Ducts

217
Q

What is the root of the subcostal nerve?

A

T12

218
Q

What is the general demarcation of parasympathetic innervation by the vagus nerve vs pelvic splanchnic nerves?

A

Vagus nerve in the thorax and abdominal organs until the left colic flexure, then pelvic splanchnic nerves take over

219
Q

Which Omentum is attached to the duodenum, transverse colon and stomach?

A

Greater

220
Q

What does the Inguinal Ligament attach to?

A

ASIS and Pubic Tubercle

221
Q

What has to rupture to allow the Urogenital sinus and anal canal to be open to the exterior?

A

Cloacal Membrane

222
Q

What 4 hormones “tend to stimulate contractions”?

A

Gastrin
CCK
Motilin
Insulin

223
Q

What artery is the root of the mesentery associated with?

A

ileocolic a.

224
Q

What type of fibers dominate the stomach mucosa?

A

Reticular and Collagen

225
Q

The pancreas is often confused with the parotid. What two types of cells would you identify the pancreas by using stain?

A 
Acinar Cells (intense stain)
Centroacinar Cells (light stain)
226
Q

What two parts of the Liver’s visceral surface are not covered with peritoneum?

A

At the gall bladder and Porta Hepatis

227
Q

What is the lowest derivative of the foregut?

A

Upper Duodenum

228
Q

What parts of the GI tract does the Vagus nerve give parasympathetics to?

A

Cecum, Ascending and Transverse Colon

229
Q

What does having a hairy chest reduce your chances of?

A

Cerrhosis

230
Q

Where are the majority of Hirschprung resections?

A

Short Segment in rectosigmoid region

231
Q

What are the 4 Secondarily retroperitoneal viscera?

A

Duodenum
Pancreas
Ascending and descending colon

232
Q

What joints the Aorta at its diaphragmatic opening at T12?

A

Thoracic Duct

sometimes azygous and hemiazygous

233
Q

What creates the arrangement of different cells around the sinusoids of adjacent liver lobules?

A

[O2] gradient created by arterial blood flow

234
Q

Where would you find Microfold Cells?

A

Ileal Mucosa, atop Peyers Patches

235
Q

What two structures come together to form the Hepatopancreatic Ampulla (of oddi)?

A

Bile Duct (of the gallbladder) and Main Pancreatic Duct

236
Q

Hepatocytes are arranged into plates, supported by reticular fibers, and separated by sinusoids. What are these plates arranged around?

A

Central Vein

237
Q

What does the inferior epigastric a anastamose with?

A

Superior Epigastric a.

238
Q

Hepatocytes are arranged in cords within the liver. what do they secrete?

A

Bile

239
Q

A patient has cramp-like (colicky) pain. What type of thing does this come from?

A

Obstructions of hollow muscular viscus (bowel, ureter)

240
Q

Passing a kidney stone hurts like hell. Where would a patient have pain that leads you to suspect it as a diagnosis?

A

Back

241
Q

What 3 things do the Lesser Splanchnic Nerve Supply?

A

Jejunum and Ilium
Cecum
Ascending and Transverse Colon

242
Q

What are all the lymphatics of the posterior abdominal wall collected into?

A

Cisterni chyli

243
Q

What is the significance of the midgut returning to its cavity after all that rotation?

A

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
Q

The liver starts as a diverticulum, and then forms its components from both endoderm and splanchnic mesoderm. What are the mesoderm parts?

A

Stromal Cells
Kupffer Cells
Stellate Cells

245
Q

How does the Entero-Gastric Reflex inhibit gastric emptying in response to fats in the duodenum?

A

CCK and GIP are released, directly inhibiting motility.

246
Q

What do the descending and sigmoid colon and rectum get their parasympathetics from?

A

Pelvic nerves S2-S4

247
Q

Which liver fissure contains the ligamentum teres?

A

Left Sagittal fissure

248
Q

What is the root of the ilioinguinal n..

A

L1

249
Q

If you have an accessory pancreatic duct, how did it get there?

A

Dorsal Pancreatic duct remains connected to the duodenum when it reconnects to the ventral pancreatic duct

250
Q

Which kind of peristaltic wave can occur after Vagotomy?

A

Secondary (also controlled by ENS, not just medulla)

251
Q

What does the internal vs external spermatic facia come from?

A

Internal is from the Transversalis fascia

External is from the External Oblique

252
Q

Innocuous imput usually travels via parasympathetics and pain usually travels via sympathetics. What is the exception?

A

Below the pelvic pain line (middle of the sigmoid colon)

Pain travels with with Parasympathetics

253
Q

What two landmarks would you find at the superior constrictor?

A

Cricoid cartilage, pharynx

254
Q

What does the genitofemoral n. supply?

A

Motor to Cremaster

Sensory to medial thigh and scrotum / Labia

255
Q

What plane do you find at the 8th rib / L1?

A

Transpyloric Plane

256
Q

What type of incision do you associate with McBurneys point (appendectomy)?

A

Gridline

257
Q

What do the apical surface receptors of M cells bind?

A

Gram Negative Bacteria (E Coli) and Certain Macromolecules

258
Q

Where would you expect to find cardiac esophageal glands?

A

Lamina propria of Terminal Esophagus (protective)

259
Q

What are the arteries (and their branches) that supply the jejunum?

A

Arcades and their branches (vasa rectae)

260
Q

What is the origin of the Vagus nerve?

A

Dorsal Motor Nucleus (medulla)

261
Q

You can have low, intermediate, and high Imperforated Anus. Where is the Distinction?

A

Relative to the Levator Ani and pelvic bony landmarks

262
Q

What does ACh do to slow waves?

A

Increases the Amplitude

263
Q

What part of the mucosa can you find the muscular mucosae of the esophagus?

A

Lower segment only

264
Q

What are the two targets of the spinal nerve pathway (sympathetic)?

A

Blood Vessels

Arrector Pili

265
Q

What structures do ducts use to propel products?

A

Myoepithelial cells

266
Q

What does the gastro-enteric (gastro-ileal) reflex do?

A

gastric distention relaxes ileocecal sphincter

267
Q

Where in the inguinal / hasselbach’s triangle would you get a femoral hernia?

A

Below the inguinal ligament

268
Q

How do you get Barretts Esophagus?

A

GERD

269
Q

What structural difference allows sympathetic information from the thoracolumbar regions to be carried all throughout the body?

A

Gray rami are connected to all spinal nerves, not just T1 - L2 like white rami.

270
Q

What three structures grow into the Ventral Mesentery for pancreas formation?

A

Cystic Diverticulum
Ventral Pancreatic Bud
Endodermal Bud

271
Q

What does the Migrating Motor Complex do?

A

Empties large particles of undigested reside

272
Q

You see a big cell thats crazy fucking eosinophilic. What is it and how did it get So. Damn. Eosinophilic.

A

Parietal cells with their beaucoup Mitochondria

273
Q

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?

A

Omphalocele

274
Q

What abdominal ligament would you associate with high speed collisions?

A

Suspensory Ligament of Duodenum (Treitz)

275
Q

What abdominal complaint is suggested by previous history of surgery?

A

Adhesive small bowel obstruction

276
Q

What happens in the absence of the MMC?

A

Small Intestinal Bacterial Overgrowth (colon bacteria in the small intestine)

277
Q

Sx: Neonatal jaundice, white clay colored stools, dark urine. Whats the Disease and treatment?

A

Biliary Atresia

Liver Transplant

278
Q

What is the origin of the iliopubic tract?

A

thickened Transversalis Fascia on the floor of the inguinal canal

279
Q

What ligament forms as the psoas fascia thickens?

A

Medial Arcuate L.

280
Q

Which branch of the external iliac a. runs deep along the inguinal ligament?

A

Deep Circumflex Iliac a.

281
Q

What innervates the Transversus Abdominis m?

A

T7 - L1

282
Q

Zymogen granules contain digestive enzymes. What type of cell would you expect to see them in?

A

Pancreatic Acinar Cells

283
Q

What proteins do we associate with parasympathetic gut action?

A

Gastrin

Motilin

284
Q

What are the three constriction sites of the ureter?

A

Its junction with the Renal Pelvis
Crossing the Pelvic Brim
Entering the Bladder Wall

285
Q

Besides injury to the Vagus nerve, what disease can cause Gastroparesis?

A

DM 1

286
Q

What do Lesser Splanchnic Nerve postganglionic fibers travel with?

A

Branches of the SMA

287
Q

Where does the duodenal obstruction or stenosis have to happen to give a paten bilious vomiting with their annular pancreas?

A

Inferior to bile duct

288
Q

Where do the midgut derivatives start and end?

A

Starts at the lower duodenum

Ends at the proximal 2/3 of the transverse colon

289
Q

What do M Cells Do?

A

Antigen Transport

290
Q

What four things do you associate with enteroendocrine cell release?

A

Gastrin
Secretin
GIP
CCK

291
Q

What separates the right and left liver?

A

Cantlie Line

292
Q

The limited abdominal space means the gut has to herniate out. What happens if theres a problem with it going back in?

A

You get Omphalocele

293
Q

Where do Splanchnic nerves terminate?

A

Pre-Vertebral Ganglia

294
Q

Where would you find the Myenteric Plexus of Auerbach?

A

Between the Inner Circular and Outer Longitudinal layers of Muscularis

295
Q

Where does the greater splanchnic nerve synapse?

A

celiac ganglion

296
Q

What segments are in the left liver?

A

I - IV

297
Q

What week is bile formed by the hepatic cells?

A

Week 12 on

298
Q

What is the main histological differences within the gallbladder, and where are they?

A

Against the Liver: External Adventita

Exposed to Peritoneal Cavity: Serosa

299
Q

What roots are the 3rd and 4th Lumbar Splanchnic nerves associated with?

A

3rd: L3
4th: L4 and L5

300
Q

What organs are responsible for pain (initially) in the suprapubic or hypogastric areas?

A

Hindgut organs (most of colon, half of sigmoid)

301
Q

What kind of epithelium is found in the striated duct of the salivary gland?

A

Simple Cuboidal-to-Columnar

302
Q

Where do the hindgut derivatives start?

A

Distal 1/3 of the transverse colon

303
Q

Where do the L and R vagus nerves and lesser sac end up after the first 90 degrees of stomach rotation?

A

Left is Ventral
R is dorsal
Lesser sac is behind it

304
Q

If you stuck a pin through the layers surrounding the descending testes, what structures would it pass through (superficial to deep)?

A

External Oblique, Internal Oblique, Transversus Abdominis

Transversalis Fascia, Subserous Fascia, Peritoneum

305
Q

Simple Columnar is found in the stomach, and both large and small intestines. What is the functional and structural differences between these?

A

Stomach: Secretory with glands
Small Intestine: Absorptive with villi and crypts
Large Intestine: Does both with Goblet cells

306
Q

What happens with Cholelithiasis to cause pancreatitis?

A

Gall stone blocking the hepatopancreatic ampulla, which means both the common bile duct and main pancreatic duct are blocked.

307
Q

What do the bile canaliculi drain into?

A

Canals of Hering

308
Q

What is the ratio of oxygen/nutrients by zone in the hepatic acinus?

A

Zone 1: High [o2 / nutrients]

Zone 3: Low [o2 / nutrients}

309
Q

What plane does the transverse colon lie in?

A

Subcostal Plane

310
Q

What is the functional unit of the Exocrine pancreas?

A

Serous Acinus

311
Q

What is the root of the iliohypogastric n?

A

L1

312
Q

What is the fate of the processus vaginalis?

A

Becomes Tunica Vaginalis

313
Q

What lobes does the porta hepatis separate?

A

Caudate and Quadrate

314
Q

The embryonic derivatives of the anal canal is divided into thirds. What are they?

A

Top 2/3 is endoderm

Lower 1/3 is ectoderm

315
Q

What does somatic pain come from?

A

Parietal Peritoneum irritation because the diseased organ is creating friction

316
Q

What is the embryological origin of the medial umbilical fold?

A

Obliterated Umbilical Arteries

317
Q

What ligaments are made by the external oblique?

A

Inguinal Ligament
Lacunar Ligament
Opening of superficial inguinal ring

318
Q

in the 5th week of development, the ventral pancreas migrates posteriorly to fuse with what?

A

Dorsal Pancreas to form the head, body, tail

Ventral pancreas to form Uncinate process

319
Q

the first two Lumbar splanchnic nerves are distributed with branches of the IMA. What three places do they go?

A

Descending Colon
Sigmoid Colon
Proximal Rectum

320
Q

What is the hallmark of Colon histology?

A

Simple Columnar glands with lots and lots of Goblet Cels

321
Q

What do the sacral Splanchnic Nerves ride to get to the pelvic visceral and perineum?

A

Internal Iliac Artery

322
Q

The muscularis of the esophagus is divided into thirds. What kinds of muscle do you find throughout?

A

Starts as Skeletal in the upper third, combines with smooth in the middle, and is exclusively smooth in the lower 1/3

323
Q

Which segments are in the Right Liver?

A

V - VIII

324
Q

What two conditions can create a secondary peristaltic wave?

A

Primary wave fails to empty the esophagus

Gastic contents reflux into the esophagus

325
Q

Which type of pain can be localized to its corresponding dermatome?

A

Parietal

326
Q

The anal transition zone separates the epithelium across the pectinate line. Whats the difference on the inside vs out?

A

Inside is simple columnar

Outside is stratified squamous

327
Q

What three GI elements does the splanchnic mesoderm form?

A

Muscular wall
Vascular Elements
Connective Tissue Elements

328
Q

What modulates the MMC?

A

Motilin

329
Q

What innervates the external oblique?

A

Ventral rami of T7 - 12 intercostal n.

330
Q

What Arteries can you find on the superior side of the diaphragm?

A 
Musculophrenic and pericardiacophrenic (off int thor)
Superior Phrenic (off thoracic aorta)
331
Q

What plane does the appendix and sigmoid colon lie in?

A

Interspinous Plane

332
Q

What three ganglia are considered pre-vertebral?

A

Celiac and the mesenteries

333
Q

The serosa layer is made of Mesothelium. When would you see this on the digestive tube?

A

When its suspended by a mesentery / peritoneal fold. Otherwise, they have an adventitia.

334
Q

What is the role of cells that distinguish the hepatic sinusoids?

A

Phagocytosis (they’re stellate macrophages)

This is Kupffer cells

335
Q

What fold would you associate with the supravesicular fossa?

A

Median Umbilical Fold

336
Q

What happens with the obliques and transversus abdominis at the arcuate line?

A

They all become anterior to the rectus abdominis

GIGU (3 decks)

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