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Gastrointestinal > Upper GI > Flashcards

Upper GI Flashcards

1
Q

What are the four histological layers of the GI tract?

A

Mucosa
Submucosa
Muscularis externa
Serosa

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2
Q

What type of epithelium are the proximal and distal ends of the GI tract?

A

Stratified squamous, nonkeratinized

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3
Q

What type of epithelium is the majority of the GI tract?

A

Simple columnar

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4
Q

What are the two nerve plexi of the GI system?

A

Submucosal (Meissner’s)

Myenteric (Auerbach’s)

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5
Q

What is the function of the submucosal (Meissner’s) plexus? Parasympathetic or sympathetic innervation?

A

Regulate the activity of the muscularis mucosae and secretion of glands/blood flow

Parasympathetic

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6
Q

What is the function of the Myenteric (Auerbach’s) plexus? Parasympathetic or sympathetic innervation?

A

Regulates the activity of the muscularis externa

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7
Q

What is the Z-line in the distal esophagus?

A

Where stratified squamous epithelium meets stratified columnar (esophagus to cardiac region of the stomach, just distal to the esophageal sphincter)

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8
Q

What is the outermost layer of the mucosae?

A

Muscularis mucosae

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9
Q

Where are lymphatics found in the GI Tract layers?

A

Submucosa

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10
Q

What are the layers of the GI tract?

A

Mucosa
Submucosa
Muscularis externa (propria)

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11
Q

What is the outermost layer of the GI tract? What is the exception to this?

A

Serosa

Esophagus has an outer coat of epithelium, not a serosa

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12
Q

Where are glands found in the GI tract? What are the two exceptions to this?

A

Submucosa

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13
Q

What does the myenteric plexus lie between?

A

Internal circular and external longitudinal muscularis layers

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14
Q

What is Barrett’s esophagus?

A

Change of the distal esophagus from stratified squamous to simple columnar with goblet cells. This is precancerous (adenocarcinoma)

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15
Q

What is the stain that is used to identify goblet cells? What is this staining?

A

Alcian blue stains the acidic mucosubstances secreted by the goblet cells

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16
Q

What third of the esophagus is most likely to harbor an adenocarcinoma?

A

distal third

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17
Q

What third of the esophagus is most likely to harbor a squamous cell carcinoma?

A

Middle third

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18
Q

How do you determine the staging of esophageal stratified squamous cell carcinoma?

A

How far the squamous cells infiltrate the esophagus

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19
Q

Who is particularly at risk of squamous cell carcinoma?

A

AA
EtOH abuse
Men

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20
Q

What type of esophageal cancer would most likely cause hoarseness: SCC or adenocarcinoma? Why?

A

SCC–can penetrate the wall of the esophagus, and hit the recurrent laryngeal nerve (from CN X)

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21
Q

What are the four anatomical esophageal constrictions?

A
  1. upper esophageal sphincter
  2. Aortic arch crosses
  3. Left bronchus
  4. Esophageal hiatus at the diaphragm
22
Q

What vertebral level is the diaphragm at?

23
Q

What is pill esophagitis?

A

When patients have difficulty swallowing pills secondary to lower muscles tone of the esophagus

24
Q

Why is SCC more common in the middle third?

A

Surrounded by strictures, possibly, but not totally known

25
Q

What is the common site for diverticula in the esophagus?

A

Gap between oblique fibers of the thyropharyngeus and the Cricopharyngeus muscle

(Killian’s triangle)

26
Q

What are pharyngoesophageal diverticulum?

A

Penetration of the mucosa + submucosa through the walls of the pharynx

27
Q

What are the symptoms of pharyngeal esophageal diverticulum?

A

Extreme halitosis

28
Q

What is the arterial supply of the esophagus?

A

Esophageal branches of the aorta

29
Q

What is the blood supply to the upper part of the esophagus?

A

Inferior thyroid artery

30
Q

What is achalasia?

A

Loss of the inhibitory neurons in the esophagus (which secrete NO and VIP).

31
Q

“Crow’s beak” appearance of the esophagus = ?

32
Q

Lymph flow in the esophagus tends to move where? (what direction, and in what layer)

A

Superiorly/inferiorly in the lamina propria, submucosa, and muscularis externa

33
Q

Lymph flow in the colon go where?

A

Laterally in the submucosal lymph channels

34
Q

A tumor in the superior esophagus tends to spread where?

A

Cervical lymph nodes, IJV, subcarina nodes

35
Q

A tumor in the inferior esophagus tends to spread where?

A

Abdominal cavity

Celiac and cardiac nodes

36
Q

What is the main lymph node in the abdomen?

A

Cisterna chyli

37
Q

What is a chylothorax?

A

Damage to the left thoracic duct may result in back up of lymph into the abdomen

38
Q

What are the G cells of the stomach?

A

Gastrin producing cells that stimulate parietal cells to secrete HCl

39
Q

What is the role of the parietal cells?

A

Secrete HCl

40
Q

Where are G cells particularly found?

A

Pylorus of the stomach

41
Q

What layers do ulcers penetrate through?

A

To the muscularis propria

42
Q

Where are most ulcers found in the stomach?

A

Lesser curvature of the stomach

43
Q

What is Zollinger-Ellison syndrome?

A

Tumors of gastrin producing cells in the gastrinoma triangle

44
Q

What are the vertices of the gastrinoma triangle?

A
  1. Junction of the cystic duct and common hepatic duct
  2. Junction of the neck and body of the pancreas
  3. Junction of the 2nd and 3rd parts of the duodenum
45
Q

What happens to the rugae in the stomach with zollinger-ellison syndrome?

A

Expanded due to increase in parietal cell mass

46
Q

What are the 6 primary arteries of the stomach?

A
  1. Right gastric
  2. Left gastric
  3. R gastro-omental
  4. L gastro-omental
  5. Gastroduodenal
  6. Splenic
47
Q

What is the potential problem with ligation of the left gastric artery?

A

Need to make sure that there is not a left hepatic artery is not a branch of the left gastric

48
Q

What are the three branches of the celiac artery?

A

Common hepatic
Splenic
Left gastric

49
Q

What are the two muscles that comprise the inferior pharyngeal constrictor? Name them superior to inferior.

A

Thyropharyngeus

Cricopharyngeus

50
Q

What is Killian’s triangle, and what is its significance?

A

Area between the thyropharyngeus and the cricopharyngeus, and is a potential site of weakness for diverticula or rupture during endoscopy

51
Q

What are Zenker’s diverticula?

A

Pharyngoesophageal diverticula in Killian’s triangle

52
Q

What is the area of the stomach that is removed in refractory PUD? Why?

A

The pyloric antrum

Where the gastrin cells are

Gastrointestinal (42 decks)

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