Upper GI

Question 1

composition of esophagus muscle wise

Answer 1

upper 1/3 is skeletal muscle, lower 2/3 is smooth muscle - inner layer is smooth circular and outer is longitudinal

Question 2

where is the esophagogastric junction

Answer 2

left of T11

Question 3

junction of stomach and esophagus

Answer 3

1. cardia

2. z line

Question 4

significance of the z line

Answer 4

mucosa changes from stratified squamous to simple columnar epithelium, superior to the line diapgragmatic musculature surrounding esophagus functions as inferior esophageal spincter

Question 5

blood supply ABDOMINAL esophagus

Answer 5

1. branches of left gastric artery

2. inferior phrenic arteries (off abd aorta)

Question 6

sympathetic innervation of esophagus

Answer 6

greater splanchnic nerves

Question 7

parasympathetic innervation of esophagus

Answer 7

vagus nerve (esophageal plexus)

Question 8

2 constriction points in esophagus

Answer 8

1. thoracic constriction (bronchoaortic)

2. diaphragmatic constriction

Question 9

para-esophageal hernia

Answer 9

cardia remains in place, z line remains in place, fundus of stomach pops through diaphragm LESS COMMON

Question 10

sliding esophageal hernia

Answer 10

abdominal portion of esophagus, cardia, and maybe some fundus of stomach slide above diapgragm (z line displaced) MORE COMMON

Question 11

causes of GERD

Answer 11

1. sliding hiatal hernia

2. decreased tone of lower esophageal spincter

Question 12

causes of peptic ulcers

Answer 12

1. mucosa exposed to gastric acid

2. H pylori

Question 13

what structures lie posterior to the pyloric spincter/first part of duodenum?

Answer 13

portal vein, bile duct, neck of pancreas, gastroduodenal artery with its anterior and posterior superior pancreaticoduodenal arteries

Question 14

what structures lie posterior to the pylorus of the stomach

Answer 14

celiac trunk, aorta

Question 15

lymphatic drainage of the stomach

Answer 15

gastric and pyloric lymph nodes

Question 16

venous drainage of stomach

Answer 16

celiac veins to the portal venous system

Question 17

blood supply stomach

Answer 17

celiac trunk as the left gastric, splenic (gastroomental, short gastric), right gastric, gastroduodenal as the right gastroomental)

Question 18

psns innervation stomach

Answer 18

vagus nerves

Question 19

sns innervation stomach

Answer 19

greater splanchnic nerves

Question 20

what is the gastric canal

Answer 20

groove between rugae and lesser curvature

Question 21

3 muscle layers of stomach

Answer 21

1. outer longitudinal layer
2. middle circular layer
3. inner oblique fibers
   =muscularis extrema

Question 22

stomach located where

Answer 22

left hypochondrium, left epigastric and umbilical regions

Question 23

what ligament contains portal triad

Answer 23

hepatoduodenal ligament in the lesser omentum

Question 24

cardia

Answer 24

esophagogastric junction

Question 25

fundus

Answer 25

above and to left of cardia may have air

Question 26

cardiac notch

Answer 26

between cardia and fundus

Question 27

pyloric antrum

Answer 27

begins at angular notch

Question 28

pyloric canal

Answer 28

narrower portion of pylorus

Question 29

pylorus

Answer 29

distal spincteric region

Question 30

what is the celiac ganglia

Answer 30

fibrous bundle that receieve fibers from greater splanchnic nerve, and send out postganglionic fibers called celiac plexus

Question 31

length of small intestin

Answer 31

6-7 meters

Question 32

characteristics of the 1st part of duodenum

Answer 32

LACKS plicae circularis, peritonealized, anterior to bile duct,portal vein, gastroduodenal artery, prone to ulcers bc pancreatic bicarb doesnt dump here to neutralize gastric contents

Question 33

characteristics of 2nd part of duodenum

Answer 33

secondarily retroperitoneal, plicae circulares PRESENT, common bile duct and main pancreatic duct open into duodenal papilla (duodenopancreatic ampulla of vater) - END OF FOREGUT

Question 34

characteristic of 3rd part of duodenum

Answer 34

CIRCULAR FOLDS PRESENT, secondarily retroperitoneal, posterior to SMA, crosses L3, BEGINNING OF MIDGUT

Question 35

characteristic of 4th part duodenum

Answer 35

CIRCULAR FOLDS PRESENT, to left of midline secondarily retroperitoneal, supported by suspensory ligament of duod = ligament of trietz, ends at duodojejunal flexures

Question 36

where is the ligament of trietz

Answer 36

smooth muscle that passes from the right crus of diaphragm around the esophagus and attaches to the muscle in duod at duodenojejunal flexure - IS A FIXED POINT IN POST ABD WALL

Question 37

nutcracker position

Answer 37

3rd part of duodenum is between the origin of SMA and aorta (neck of pancreas is anterior to aorta and superior to 3rd part)

Question 38

division of foregut, midgut, hindgut

Answer 38

FOREGUT: esophagus to duodenal papilla, blood celiac trunk, sympathetics greater splanchnic n, parasympathetics vagus n MIDGUT: duodenal papilla to 2/3 of transverse colon, blood SMA, sympathetics lesser splanchnics, parasympathetics vagus n HINDGUT: 1/3 transverse colon to rectum, blood IMA, sympathetics lumbar splanchnics, parasympathetics pelvic splanchnic (S2-S4)

Question 39

lymphatic drainage duod

Answer 39

pyloric nodes, SM lyphnodes

Question 40

specific blood to duod

Answer 40

1. superior A&P pancreaticoduodenal from gastroduodenal A 2. inferior A&P pancreaticoduodenal from SMA

Question 41

where does jejunum begin

Answer 41

L2 at duodenojejunal flexure on left side

Question 42

where does ileum end

Answer 42

ileocecal junction

Question 43

what is meckel's diverticulum?

Answer 43

leftover of umbilical cord! remnant of proximal part of yolk sac that follows the rule of 2's: 2 inches long, 2 feet from ileocecal junction, and only occurs in 2% of population

Question 44

position of jejunum and ileum

Answer 44

jejunum: ULQ ileum: LRQ

Question 45

distinguishing characteristics of jejunum

Answer 45

jejunum: deeper red/greater vascularity, 2-4 cm, thick and heavy, long vasa recta, few large archades, less fat in mesentery, large circular folds, few peyer's patches (lymphoid nodules)

Question 46

distinguishing characteristics of ileum

Answer 46

paler pink, 2-3 cm, thin and light, short vasa recta, more small archades, more fat in mesentery, low and sparce circular folds, has more peyer's patches

Question 47

lymphatic drainage of jejunum and ileum

Answer 47

superior mesenteric and ileocolic lymph nodes