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GI Exam 1 > Upper GI Anatomy > Flashcards

Upper GI Anatomy Flashcards

1
Q

Basic architecture of GI wall:

A
  • Four main layers:
    1) mucosa -
    a) epithelium on basal lamina
  • stratified squamous in proximal and anal canal bu everything inbetween is simple columnar
    b) lamina propria
  • has lymphatics
  • ALL GLANDS EXCEPT DUODENAL AND ESOPHAGUS
    c) muscularis mucosae
    2) submucosa -
  • has lymphatics
  • HAS GLANDS ONLY DUODENUM AND ESOPHAGUS
    3) muscularis externa/propria
  • inner circular
  • outer longitudinal
    4) Serosa
  • esophagus has adventitia - no mesothelium
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2
Q

Submucosal (Meissners) Plexus:

A

a) parasympathetic postganglionic neurons and their processes and sympathetic postganglionic fibers; b) regulates:
- the activity of the muscularis mucosae,
- the secretory activity of glands, and blood flow.

**-muscular contractions, glands, and blood flow

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3
Q

Myenteric (auerback’s) plexus:

A

a) parasympathetic postganglionic neurons and sympathetic postganglionic fibers;
b) regulates the activity of the muscularis externa (inbetween circular and longitudinal muscular layer)

-controls peristalsis

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4
Q
  • Achalasia-
  • what happens?
  • What components involved?
  • appearance term?
A
  • distal esophagus- loss of inhibitory neurons that make up the myentic plexuc - relax the smooth muscle (hyperpolarize) after you swallow.
  • So if these nerves arent working you get a lot of contraction of distal esophagus = birds beak appearance
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5
Q

*Hirschsprung disease

A

-rectum

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6
Q

Barretts Esophagus

A
  • metaplasia stratified squamous to simple columnar with goblet cells (mucous secretion for protection)
  • z-line demarcation between stomach and esophagus is not clear
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7
Q

How to confirm Barretts esophagus?

A

Need to see goblet cells with alcian blue stain - stains acidic muco-substances

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8
Q

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

A

distal third - usually due to barretts

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9
Q

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

A

middle third!

due to alcohol and or tobacco use

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10
Q

What type of esophageal cancer would most likely cause hoarseness?

A

SCC - why? Bc recurrent alryngeal nerve loops around aorta right around the middle third of the esophagus where SCC would most likely occur

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11
Q

Esophageal constriction areas:

A

i. At level of UES (junction of esophagus with pharynx - cricopharyngeus muscle)
ii. At level of aortic arch
iii. At level of left primary (main) bronchus
iv. Diaphragmatic where esophagus passes through esophageal hiatus (level of T10) of diaphragm

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12
Q

Endoscopy - relationship to esophageal constrictions?

A
  • need to be cautious with constrictions to not penetrate wall of esophagus at junctions
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13
Q

Pill esophagitis - relationship to esophageal constrictions? Age group most affected?

A
  • pills can get lodged at constriction areas = may cause irritation and inflammation
  • elderly most affected- their esophagus has less motility and decreased saliva (lubrication)
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14
Q

Esophageal diverticula:

1) weakness exists where in the wall?
2) name of diverticulum formed?

A
  • cricopharyngeus and thyropharyngeus muscles have a transition area between them = Killian triangle.
  • Pharyngoesophageal (Zenker’s) diverticulum (70%) - rotting food that gets stuck there or endoscopy can poke through easy
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15
Q

Where would you ligate the inferior thyroid artery when performing a thyroidectomy?

A
  • need to maintain arterial supply to esophagus (provided by inf thyroid artery) so you need to ligate at an area AFTER the cervical branch to the esophagus has been given off.
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16
Q

esophageal varicies and veins

-when?

A
  • usually with hepatic portal hypertension -liver cirrhosis
  • blood trying to get back to heart but cant go through liver = use esophageal veins so veins are huge = could burst = spitting/vomiting blood
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17
Q

Where do lymph and metastatic cells flow more readily?

-significance of these areas of flow?

A

-in the submucosal lymphatic channels

  • submucosal lymphatics arranged longitudinally so the metastatic cells can spread far crainially and caudally
  • (neck, mediastinum, and abdominal cavity can be affected)
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18
Q

lymph flow from upper third of esophagus goes..

A

to the neck LN

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19
Q

lymph flow from lower 2/3 goes to?

A

to abdominal LN such as celiac LN

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20
Q

What is a chylothorax?

A

During esophageal surgery if the thoracic duct is damaged (passes behind the esophagus) then lymph will leak into abdominal cavity

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21
Q

gastrin secreting cells are located in? what does gastrin do?

A
  • pyloric glands

- stimulates parietal cells (in glands of fundus and body of stomach) to secrete HCl

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22
Q

Ulcer - stomach:

A

inflammation in the wall of the stomach that can invade all layers of the stomach

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23
Q

If inflammation is confined to mucosa of stomach we call it a

A

erosion

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24
Q

Once inflammation in stomach gets into submucosa we call it a(n)?

A

ulcer

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25
Q

Cause of most ulcers?

A

H pylori

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26
Q

How do we treat stomach ulcers that are refractory (not responding to therapy)?

A
  • remove pylorus

- why? contain gastrin secreting cells

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27
Q

What landmark is used to distinguish body of stomach from pylorus region?

A

the angular notch

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28
Q

Zollinger-Ellison syndrome

-what is it? problem?

A

parietal cell tumor in gastrinoma triangle - secretes a lot of gastrin = a lot of HCl = really low pH = ulcers

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29
Q

Gastrinoma triangle boudaries?

A
  • where cystic and hepatic ducts meet
  • where the second part of duodenum meets thrid part of duodenum
  • where the body/neck area of the pancreas
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30
Q

What test do you do to find zollinger-ellison syndrome/gastrinoma?

A

-immunocytochemistry must be positive for gastrin in tumor biopsy

31
Q

Zollinger-ellison syndrome:

- distinguishing feature with endoscopy?

A

prominent rugae due to increased parietal cell mass

32
Q

6 arteries to the stomach?

A
  • R gastric
  • L gastric (branch from celiac trunk - feeds cardiac area)
  • R gastroomental (branch of gastroduodenal)
  • L gastroomental (branch of splenic)
  • gastruduodenal (from common hepatic a.)
  • splenic - fundic area via short gastric branches
33
Q

How may gastric blood flow be provided if celiac trunk is occluded?

A
  • Superior mesenteric connects with celiac trunk branches - inferior pancreaticoduedenal a.
  • anastamose with gastroduodenal branches
34
Q

Ligation of left gastric artery? Problems?

A

Ligation may be a problem if left gastric is giving off a branch (usually left hepatic a instead of common hepatic a splitting into L and R hepatic a’s) that feeds the liver

35
Q

Gastric vagal innervation and ulcers - how can we use this innervation to our advantage?

A
  • alternative to removing the pylorus

- We could denervate the vagal area supplying the BODY and FUNDUS = less stimulation of parietal cells

36
Q

Two main nerves from the vagus that supply stomach wall?

A
  • R vagus runs down posterior stomach –> posterior nerve or latarjet (supplies some pylorus from posterior side)
  • L vagus runs down anterior side of stomach - Anterior nerve of Latarjet (terminal branches to pylorus)

YOU WANT TO WIPE OUT PARASYMPATHETIC TO THE BODY AND FUNDUS

37
Q

How may gastric cancer progress to pancreatic duct obstruction?

A
  • 2 mech:
    a) get cancer that penetrates the posterior wall of stomach that lays on the pancreas and invades pancreas too = potential pancreatic duct obstruction
    b) more common: cancer begins at distal greater curvature and spreads into R gastro-omental LNs and the cells would move into LN that are in the head of the pancreas = possible duct obstruction
38
Q

Structural mods that increase SA in small intestines:

A

1) Plica circularis - 3x increase
2) villus- folded mucosa and lamina propria of mucosa - 10x increase
3) Microvillus - on each columnar cell -20x increase

39
Q

Where are plicae circularis better developed?

A

duodenum and jejunum

40
Q

What happens to small intestines in enteritis?

A

the plicae circulares are thickened

41
Q

Gluten enteropathy? What happens?

A

Signature features:

1) enterocytes (columnar cells) are disarrayed
2) villus atrophy
3) crypts of leiberkun (sp?) (intestinal gland) hyperplasia
4) inflammation of lamina propria (swelling + immune cells)

42
Q

How many parts to the duodenum?

A

4-

superior –> descending –> inferior or horizontal–>ascending

43
Q

Part 1 of duodenum - find wht?

A

find duodenal ulcers - 90%

44
Q

Ligament of treitz: does what?

A

Suspends duodenal flexure

45
Q

Upper GI bleed is where?

A

above ligament of trietz

46
Q

Lower GI bleed is where?

A

below ligament of trietz

47
Q

Embolic occlusion in abdomen more likely to occur where?

A

SMA - most likely
next is IMA
celiac trunk is wide and comes off almost perpendicularly

48
Q

SMA syndrome?

A

vascular compression of the duodenum by the SMA (lordosis needed too)

49
Q

Intussesception - what is it?

A

when the proximal segment telescopes into distal segment

50
Q

most common intussesception?

A

ileocolic bc of size - ileum is smaller and colon is nicely larger so good size difference for this to happen

51
Q

most common cause of intussusception

A

cancer

52
Q

most common position of appendix

A

retroceccal

retroileal

53
Q

pathogenesis of appendix?

A

usually some poop gets stuck in the appendix and glands of appendix continue to secrete stuff = increased pressure = decrease blood flow to appendix

54
Q

diverticula occur where?

A

sites of weakness in colon wall

55
Q

what layers in a false diverticulum?

A

mucosa and submucosa

56
Q

potential sites of weakness in the colon wall?

A

The longitudinal bands do not completely surround the colon tube - only have 3 bands of longitudinal muscle

where there is no longitudinal band all you have is the circular muscle = weak

parts WITH nerves and blood vessels are more weak than those without

57
Q

How may a fissue or fistula form in IBD - Crohns?

A

if the inflammation penetrates all layers

58
Q

What is a fistula?

A

when you get a fissure that break through the wall of another nearby organ … so like colon into bladder or another part of the colon or whatever

59
Q

Test for fistula bw colon and bladder?

A

give charcoal to eat - if charcoal shows up in urine you know you have a funky problem

60
Q

Crohns enterocutaneous fistula is between?

A

intestinal segment and anterior wall of abdominal wall

61
Q

Colon and cancer obstruction - more likely which side?

A

Right side -ascending and larger diameter more often cancer

But Obstruction more likely left descending bc diameter is smaller

62
Q

Which segment of the colon is most vulnerable to ischemia?

A

Critical point of griffiths - splenic flexure - the arteries are narrowest here

63
Q

Where would you ligate the IMA in open repair of an AAA?

A

proximal to the arc of riolan - connects middle colic artery and something else

64
Q

Artery the anastamoses the IMA and SMA?

A

marginal artery

65
Q

Aneurism of SMA - what happens to marginal and arc of riolan arteries?

A

Increase in size due to increase in flow through IMA

66
Q

Can rectum get diverticula?

A

NO! it has continuous layers (internal circular and longitudinal) so not much potential for weakness

67
Q

top of the anal columns is where the?

A

anal canal begins

68
Q

the distal aspect of the anal columns meets up with the?

A

pectinate line - and make a slight anal sinus and valve at this point

69
Q

Inflammatory state in the anal sinus due to poop that hardens and blocks the area off?

A

inflammation can penetrate wall and can form abscess or fistula) bw external and internal anal sphincter - most commonly moves from anal sinus and form abscess in perianal region

70
Q

most common fistula in anal area?

A

intersphincteric fistula (40%)

71
Q

what is the anatomic basis of pancreatic tumors causing ascites and jaundice?

A

jaundice - pressure on common hepatic duct and backs up into liver

ascites = pressure on hepatic portal = portal HTN = accumulation of fluid

72
Q

What is riedel’s lobe?

A

when the right lobe of the liver grows down really low into the pelvic area

73
Q

Triangle of Calot:

  • reference point for?
  • borders:
A
  • gallbladder removal

- cystic artery, cystic duct, common hepatic duct

GI Exam 1 (11 decks)

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