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Gastrointestinal > Upper GI II > Flashcards

Upper GI II Flashcards

1
Q

What is the innervation of the stomach?

A

Left vagus nerve running posterior to the esophagus, giving rise to the anterior vagal trunk

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2
Q

Which part of the vagus sits anterior to the esophagus? Posterior?

A

Left in front

Right in back

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3
Q

What is the eponym for the vagus nerve on the stomach?

A

Nerve of latarjet

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4
Q

What is the indication for ligating the vagal nerve to the stomach?

A

Refractory PUD since the vagal nerve increases gastrin sectretion

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5
Q

Why do you want to preserve the innervation to the pylorus of the stomach during a vagotomy?

A

Lessen the dumping of food into the duodenum

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6
Q

What is the nerve that is commonly missed during a vagotomy of the stomach?

A

Criminal nerve of Grassi (on the superior/posterior aspect of the stomach)

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7
Q

A patient with gastric cancer also presents with obstruction of the pancreatic ducts. Why?

A

Cancer may spread through lymph node to the head of the pancreas

Cancer could grow from stomach in direction of pancreas

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8
Q

What are the three structures of the small intestines that increase the surface area? (list in order)

A

Plica circularis
Villi
Microvilli

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9
Q

What are the four histological signs of celiac disease?

A

a. Enterocytes are disarrayed
b. Villus atrophy
c. Crypt (intestinal gland) hyperplasia
d. Inflammation of lamina propria

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10
Q

What plica circularis is a fold of what layer of the GI tract?

A

Mucosa and submucosa

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11
Q

Where in the small intestines are the plica circularis not well defined?

A

Distal ileum

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12
Q

Villi are fold of what layer of the GI tract?

A

Mucosa

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13
Q

What is the epithelium associated with the villi?

A

Simple columnar with goblet cells

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14
Q

Where are the blood vessels located within the villi? What else is in this area?

A

Lamina propria

Lacteals

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15
Q

Where do most duodenal ulcers occur?

A

Ampulla

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16
Q

What is the major issue with posteriorly located duodenal ulcers?

A

May penetrate through the wall and erode the gastroduodenal artery and pancreas

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17
Q

What is the radiological sign of an anterior duodenal perforation?

A

AIr beneath the right hemidiaphragm

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18
Q

What are the four parts of the duodenum?

A

Ampulla
Descending
Inferior (horizontal)
Ascending

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19
Q

What part of the duodenum is intraperitoneal?

A

Ampulla

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20
Q

What would happen if there is an ulcer on the anterior part of the duodenum?

A

Air will fill up peritoneal cavity

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21
Q

What is the ligament of treitz?

A

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

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22
Q

What vertebral level is the celiac artery at?

A

L1

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23
Q

Does the celiac artery run anterior or posterior to the duodenum?

A

Anterior

24
Q

An embolus traveling down the aorta will most likely enter the SMA or the celiac trunk? Why?

A

SMA since the artery comes off obliquely

25
Q

What is the “nutcracker” aspect of the SMA that can lead to SMA syndrome?

A

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

26
Q

The common bile duct and the pancreatic duct unite where?

A

Within the wall of the 2nd part forming the hepatopancreatic ampulla

27
Q

Who usually gets intussusception? What is the most common type?

A

Children

Ileum into the cecum

28
Q

What is the major issue with intussusception?

A

Infarct/necrosis

29
Q

Currant jelly appearance to the stool in a child may indicate what? What is this from?

A

Intussusception, with the stool being the sloughed off portion of the intestines

30
Q

What is Mcburney’s point?

A

1/3 distance from ASIS to the umbilicus

31
Q

What is the pathogenesis of appendicitis?

A

Goblet cells secrete into the appendix, but is blocked by a fecalith

32
Q

What is the dividing landmark between the upper and lower intestines?

A

Ligament of Treitz

33
Q

What are diverticula? What are true diverticula?

A

Outpocketings of the colonic wall, with true diverticula involving the mucosa, submucosa, and muscularis externa layers

34
Q

What is the difference between “true” and “false” diverticula?

A

True = Mucosa, submucosa, and muscularis externa involvement

False = Mucosa and submucosa

35
Q

What is the most common site of diverticula?

A

Sigmoid colon

36
Q

What is the modification to the GI tract muscular layer in the large intestine? What is the clinical significance of this?

A

Muscularis externa becomes a smaller, fibrous band (taenia coli), meaning that diverticula have an easier time forming

37
Q

What is the significance of the vasa recta from the marginal artery penetration of the small intestines?

A

Site of weakness for diverticula to form

38
Q

Why is the rectum spared when it comes to diverticula?

A

Tenia coli combine, and increase the strength

39
Q

Why is the most common site of diverticula formation in the 2nd part of the duodenum?

A

Where the pancreatic and bile duct penetrate the intestines

40
Q

What is Crohn’s disease?

A

IBD that can involve any layer of the GI tube, and can create fistulas through the GI tract

41
Q

Which side of the larger intestines is larger? What is the clinical significance of this?

A

Right side

If there is an obstruction in the left side of the intestines, it is more likely to cause an obstruction

42
Q

Which part of the intestines is more likely to produce BRBPR: left or right side?

A

Left

43
Q

What are the branches of the SMA? (4)

A

Right colic
Middle colic
Marginal
Ileocolic

44
Q

What segment of the intestine is most susceptible to ischemia? Why?

A

The left colic flexure since the marginal artery is smallest there (point of Griffiths)

45
Q

What are the branches of the IMA? (2)

A

Left colic

Sigmoid branches

46
Q

Where would you ligate the IMA to repair a AAA?

A

Proximally in the arc of Riolan to maintain blood supply to the marginal artery

47
Q

What are the three vertices of the triangle of calot? What is the significance of this?

A

Cystic artery
Cystic duct
Common hepatic duct

Aids in the removal of gallbladder

48
Q

How can pancreatic tumors create ascites and jaundice?

A

Tumors of the pancreatic head can place pressure on or invade the hepatic portal vein and common bile duct.

49
Q

True or false: pancreatic tumors can obstruct the pylorus of the stomach and the IVC

A

True

50
Q

What is the capsule that cover the liver and gallbladder?

A

Glisson’s capsule

51
Q

What hepatic zone is the main zone of alcohol and drug metabolism?

A

Zone 3

52
Q

What is the dentate (pectinate) line?

A

Line in the rectum that changes from autonomic innervation to somatic innervation

53
Q

Almost all anorectal abscesses originate from infection of what?

A

Anal glands

54
Q

What are the structures in the abdomen that are retroperitoneal?

A 
Suprasdrenal
Aorta/IVC
Duodenum
Pancreas
Ureters
Colon (descending and ascending)
Kidneys
Esophagus
Rectum

(SAD PUCKER)

55
Q

Name the layers of the GI tract from superficial to deep.

A

Serosa
Muscularis externa
Submucosa
Mucosa

56
Q

Where are the crypts of Lieberkuhn?

A

Ileum

57
Q

Where are the peyer’s patches?

A

Ileum–for immuno surveillance

Gastrointestinal (42 decks)

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