Upper GI II Flashcards
What is the innervation of the stomach?
Left vagus nerve running posterior to the esophagus, giving rise to the anterior vagal trunk
Which part of the vagus sits anterior to the esophagus? Posterior?
Left in front
Right in back
What is the eponym for the vagus nerve on the stomach?
Nerve of latarjet
What is the indication for ligating the vagal nerve to the stomach?
Refractory PUD since the vagal nerve increases gastrin sectretion
Why do you want to preserve the innervation to the pylorus of the stomach during a vagotomy?
Lessen the dumping of food into the duodenum
What is the nerve that is commonly missed during a vagotomy of the stomach?
Criminal nerve of Grassi (on the superior/posterior aspect of the stomach)
A patient with gastric cancer also presents with obstruction of the pancreatic ducts. Why?
Cancer may spread through lymph node to the head of the pancreas
Cancer could grow from stomach in direction of pancreas
What are the three structures of the small intestines that increase the surface area? (list in order)
Plica circularis
Villi
Microvilli
What are the four histological signs of celiac disease?
a. Enterocytes are disarrayed
b. Villus atrophy
c. Crypt (intestinal gland) hyperplasia
d. Inflammation of lamina propria
What plica circularis is a fold of what layer of the GI tract?
Mucosa and submucosa
Where in the small intestines are the plica circularis not well defined?
Distal ileum
Villi are fold of what layer of the GI tract?
Mucosa
What is the epithelium associated with the villi?
Simple columnar with goblet cells
Where are the blood vessels located within the villi? What else is in this area?
Lamina propria
Lacteals
Where do most duodenal ulcers occur?
Ampulla
What is the major issue with posteriorly located duodenal ulcers?
May penetrate through the wall and erode the gastroduodenal artery and pancreas
What is the radiological sign of an anterior duodenal perforation?
AIr beneath the right hemidiaphragm
What are the four parts of the duodenum?
Ampulla
Descending
Inferior (horizontal)
Ascending
What part of the duodenum is intraperitoneal?
Ampulla
What would happen if there is an ulcer on the anterior part of the duodenum?
Air will fill up peritoneal cavity
What is the ligament of treitz?
Muscle that connects the distal duodenum to the right crus ligament, and aids in the movement of chyme from the distal duodenum to the proximal jejunum
What vertebral level is the celiac artery at?
L1
Does the celiac artery run anterior or posterior to the duodenum?
Anterior
An embolus traveling down the aorta will most likely enter the SMA or the celiac trunk? Why?
SMA since the artery comes off obliquely
What is the “nutcracker” aspect of the SMA that can lead to SMA syndrome?
If there is not enough fat between the SMA and the aorta, the angle between the two will decrease, pinching off the duodenum and causing a BO
The common bile duct and the pancreatic duct unite where?
Within the wall of the 2nd part forming the hepatopancreatic ampulla
Who usually gets intussusception? What is the most common type?
Children
Ileum into the cecum
What is the major issue with intussusception?
Infarct/necrosis
Currant jelly appearance to the stool in a child may indicate what? What is this from?
Intussusception, with the stool being the sloughed off portion of the intestines
What is Mcburney’s point?
1/3 distance from ASIS to the umbilicus
What is the pathogenesis of appendicitis?
Goblet cells secrete into the appendix, but is blocked by a fecalith
What is the dividing landmark between the upper and lower intestines?
Ligament of Treitz
What are diverticula? What are true diverticula?
Outpocketings of the colonic wall, with true diverticula involving the mucosa, submucosa, and muscularis externa layers
What is the difference between “true” and “false” diverticula?
True = Mucosa, submucosa, and muscularis externa involvement
False = Mucosa and submucosa
What is the most common site of diverticula?
Sigmoid colon
What is the modification to the GI tract muscular layer in the large intestine? What is the clinical significance of this?
Muscularis externa becomes a smaller, fibrous band (taenia coli), meaning that diverticula have an easier time forming
What is the significance of the vasa recta from the marginal artery penetration of the small intestines?
Site of weakness for diverticula to form
Why is the rectum spared when it comes to diverticula?
Tenia coli combine, and increase the strength
Why is the most common site of diverticula formation in the 2nd part of the duodenum?
Where the pancreatic and bile duct penetrate the intestines
What is Crohn’s disease?
IBD that can involve any layer of the GI tube, and can create fistulas through the GI tract
Which side of the larger intestines is larger? What is the clinical significance of this?
Right side
If there is an obstruction in the left side of the intestines, it is more likely to cause an obstruction
Which part of the intestines is more likely to produce BRBPR: left or right side?
Left
What are the branches of the SMA? (4)
Right colic
Middle colic
Marginal
Ileocolic
What segment of the intestine is most susceptible to ischemia? Why?
The left colic flexure since the marginal artery is smallest there (point of Griffiths)
What are the branches of the IMA? (2)
Left colic
Sigmoid branches
Where would you ligate the IMA to repair a AAA?
Proximally in the arc of Riolan to maintain blood supply to the marginal artery
What are the three vertices of the triangle of calot? What is the significance of this?
Cystic artery
Cystic duct
Common hepatic duct
Aids in the removal of gallbladder
How can pancreatic tumors create ascites and jaundice?
Tumors of the pancreatic head can place pressure on or invade the hepatic portal vein and common bile duct.
True or false: pancreatic tumors can obstruct the pylorus of the stomach and the IVC
True
What is the capsule that cover the liver and gallbladder?
Glisson’s capsule
What hepatic zone is the main zone of alcohol and drug metabolism?
Zone 3
What is the dentate (pectinate) line?
Line in the rectum that changes from autonomic innervation to somatic innervation
Almost all anorectal abscesses originate from infection of what?
Anal glands
What are the structures in the abdomen that are retroperitoneal?
Suprasdrenal Aorta/IVC Duodenum Pancreas Ureters Colon (descending and ascending) Kidneys Esophagus Rectum
(SAD PUCKER)
Name the layers of the GI tract from superficial to deep.
Serosa
Muscularis externa
Submucosa
Mucosa
Where are the crypts of Lieberkuhn?
Ileum
Where are the peyer’s patches?
Ileum–for immuno surveillance
