Witwer - GI Flashcards
1
Q
what structures are intraperitoneal
A
stomach
1st part of duodenum
jejunum
ileum
transverse colon
sigmoid colon
liver
spleen
2
Q
intraperitoneal organs are situated in the __ part of the peritoneal membrane
and completely covered with
A
interior
visceral peritoneum
3
Q
what structures are retroperitoneal
A
SAD PUCKER
suprarenal (adrenal) gland
aorta/IVC
duodenum
pancreas (minus tail)
ureters
colon (ascending and descending)
kidneys
esophagus
rectum
4
Q
visceral peritoneum, parietal peritoneum,
and peritoneal cavity
A
5
Q
the peritoneal cavity can be divided into
A
greater and lesser peritoneal sacs
6
Q
the greater sac is divided into two compartments by the
A
transverse colon
7
Q
what are the compartments of the greater sac
A
supracolic compartment
infracolic compartment
8
Q
free intra-abdominal air can be either intraperitoneal or extra-peritoneal, but is often __
A
retroperitoneal
9
Q
what imaging can be useful to evaluate abdominal pain
A
chest films
10
Q
lung or pleural dz can manifest as
A
abdominal pain
11
Q
what is pneumo-peitoneum
A
free air beneath the diaphragm 2/2 to abd viscus
12
Q
how will pneumo-peritoneum appear on chest film
A
it will gravitate under the diaphragm on an upright film
13
Q
how do you diagnose diseases of the esophagus
A
upper GI series →
barium study
or
CT
14
Q
the bird’s beak abnormality is associated w.
A
achalasia
15
Q
what do you think when you see, failure of relaxation of the distal esophageal sphincter and aperistalsis of esophageal motility
A
achalasia
16
Q
achalasia is usually __,
but can be secondary dt __ (2)
A
primary
esophageal cancer or Chaga’s dz
17
Q
what do you think when you see esophageal squamous epithelium metaplasia to columnar epithelium in a pt w. GERD
A
Barrett’s esophagus
18
Q
Barrett’s esophagus increases the risk for
A
esophageal cancer
19
Q
esophageal varices are found in patients w.
A
hepatic portal HTN
20
Q
2 types of hiatus hernia
A
sliding
fixed
21
Q
hiatus hernias are associated w. (2)
A
GERD
dysphagia
22
Q
which type of hiatus hernia is reducible
A
sliding
23
Q
the schatzki ring is a type of
A
hiatus hernia
24
Q
diseases of the stomach (2)
A
gastric ulcers
gastric malignancies
25
what do you think when you see thickened rugae
increased acid production → gastric ulcers
26
peptic ulcer dz is mc caused by
h.pylori
27
\_\_ ulcers are more common than
\_\_ ulcers
dudenal more common than gastric
28
hx for pt w. PUD might include
GERD
NSAIDs
corticosteroids
29
symptoms of PUD
epigastric pain
bleeding → hematemesis, melena
perforation
gastric outlet obstruction
30
epigastric pain for gastric ulcers will be
at mealtimes
31
gastric pain for duodenal ulcers will be
2-3 hours post prandial
32
indications for surgery for gastric ulcers
bleeding
perforation
obstruction
33
how would perforation from PUD appear on chest film
free air beneath right hemidiaphragm
34
what is zollinger ellison syndrome
gastrinoma secreting gastrin → gastrin stimulates parietal cells to secrete HCl
35
clinical findings for zollinger ellison syndrome
multiple peptic ulcers
ulcers resistant to therapy
PUD + diarrhea
fam hx MEN1
PUD w.o H.pylori or NSAIDs
36
zollinger-ellison syndrome gastrinoma triad
fulminating PUD
gastric acid hypersecretion
non-beta islet cell tumors of pancreas
37
chronic atrophic gastritis can be a precursor for
gastric carcinoma
38
mc gastric malignancy
adenocarcinoma
39
h.pylori is a risk factor for
adenocarcinoma
40
50% of gastric adenomas are found in the
curve of pylorus or antrum
41
sx of adenocarcinoma
wt loss and cachexia
plain
vomiting
melena
virchow node mets
42
what does the porta hepatis contain
common hepatic bile duct
hepatic artery proper
hepatic portal vein
43
the portal triad w.in the hepatic lobules contains (3)
arteriolar branch of hepatic artery
venule branch of portal vein
biliary ductules
44
blood supply to foregut
celiac artery
45
blood supply to midgut
superior mesenteric artery
46
blood supply to hindgut
inferior mesenteric artery
47
where does the common bile duct and pancreatic duct enter the jejunum
ampulla of vater
48
foregut contains
esophagus
stomach
proximal duodenum
liver
gallbladder
pancreas
spleen
49
contents of midgut
50
contents of midgut
distal duodenum
jejunum
ileum
cecum
appendix
ascending colon
proximal transverse colon
50
contents of midgut
distal duodenum
jejunum
ileum
cecum
appendix
ascending colon
proximal transverse colon
51
contents of the hindgut
distal transverse colon
descending colon
sigmoid colon
proximal anal canal
52
midgut volvulus is mc found in
babies
small kids
53
what is a volvulus
obstruction caused by loop of intestine that rolls or twists around itself and surrounding mesentery
54
symptoms of midgut volvulus
bilious vomiting → *rarely non bilious*
hemodynamic instability
abd distension
associated congenital defects
55
what is mesenteric ischemia
narrowed or blocked arteries restrict blood flow to small intestine → death to intestinal tissue, gangrene, perforation
56
US and color flow doppler analysis would show __ for mesenteric ischemia
blunted postprandial response
57
what artery is mc involved in mesenteric ischemia
celiac a
58
what happens in strangulation of a bowel hernia
blood supply is cut off to small intestine
59
malabsorption from celiac can mask as a
wasting dz of unknown etiology
60
post op, SBO is usually 2/2 to
an adhesion
61
with no surgical hx, SBO is usually 2/2 to
malignant obstruction
62
initial diagnostic modality for cholecystitis
US
63
US determines
presence of stones
thickness of GB wall
64
mc location for obstruction in cholecystitis
cystic duct
65
3 types of cholecystitis
acute
chronic
necrotizing
66
cholecystitis can be \_\_
or \_\_
calculous
alcalculous
67
gallstones can migrate to, or form in __ (2)
common bile duct
pancreatic duct
68
stones in the pancreatic duct can cause
pancreatitis
69
mc cause of painless jaundice
tumor in head of pancreas
70
what causes painful jaundice
common bile duct obstruction
71
mc cause of hepatitis in US
hep C
followed by etoh and metabolic dz
72
complication of cirrhosis
HCC
73
the porta hepatis contains
common hepatic bile duct
hepatic artery proper
hepatic portal vein
74
the common bile duct enters the duodenum on the __ side of the stomach
lesser curve
75
what artery supplies the common hepatic a to the hepatic a proper to the right and left hepatic a
celiac a
76
main vein of the portal veinous system
portal vein
77
the portal vein drains from the
GI tract
gallbladder
pancreas
spleen
liver
78
the portal vein joins with the \_\_
vein to form the __ vein
splenic
superior mesenteric
79
what is this showing
extensive varices 2/2 to portal htn
80
mc liver tumor
cavernous hemangioma
81
2nd mc liver tumor
focal nodular hyperplasia
82
focal nodular hyperplasia is a __ liver tumor
and has associations w. \_\_
benign
OCP
83
what is this showing
cavernous hemangioma → appear bright on T2
84
what is this showing
cavernous hemangioma →
fill in of hemangioma gradually from arterial phase to portal veinous phase
85
diffuse metastatic breast carcinoma to the liver can cause \_\_
and __ enlargement
portal htn
umbilical vein
86
what is this showing
abnormal low intensity signal from iron deposition
## Footnote
**→ hemochromatosis**
87
the common bile duct
and the __ join and empty contents into the
\_\_
pancreatic duct
duodenum
88
endocrine fxns of the pancreas
**glucose regulation →**
insulin
glucagon
somatostatin
89
exocrine fxns of pancreas
**digestive enzymes →**
trypsin
chymotrypsin
amylase
lipase
90
2 mc causes of pancreatitis
gallstones
etoh
91
sequela of pancreatitis
chronic pancreatitis
scarring
pseudocyst formation → mass effect
loss of functioning tissue
92
what is this showing
large pseudocyst in head of pancreas
93
what do you think when you see this triad:
fulminating PUD
gastric acid hypersecretion
non-beta islet cell tumors of pancreas
zollinger-ellison syndrome → gastrinoma
94
mc type of pancreatic ca
adenocarcinoma of pancreas
95
where does adenocarcinoma of the pancreas start
exocrine glands
96
what is this showing
mass in the head of the pancreas encasing/displacing portal vein → adenocarcinoma
97
classic presentation of appendicitis
peri-umbilial pain
followed by RLQ pain
98
why does appendicitis pain migrate from peri-umbilical to RLQ
as appendix becomes more inflamed → pain localizes
99
point on RLQ of abdomen where tenderness is maximal in acute appendicitis
mcburney's point
100
distress and pain in epigastric, umbilical, and praecordial regions on steady pressure over mcburney's point
aaron's sign → **chronic appendicitis**
101
potential complications of diverticulosis/diverticulitis
intramural abscess
colovaginal fistula
colon carcinoma
101
potential complications of diverticulosis/diverticulitis
intramural abscess
colovaginal fistula
colon carcinoma
102
currant jelly stools
intussusception
103
dx imaging for intussusception
US
104
tx for intussusception
barium enema
OR
water soluble contrast enema
105
pseudomembranous colitis is often caused by
cdiff
106
what do you think when you see:
nodular wall thickening of large bowel wall and haustra
thumbprinting
pseudomembranous colitis
107
what causes thumbprinting
bowel wall edema
108
what is this showing
thumbprinting
bowel wall edema
**pseudomembranous colitis**
109
complications of UC
toxic megacolon
malignancy
110
what do you think when you see pseudopolyposis
UC
111
what is this showing
pseudopolyposis →
## Footnote
**UC**
112
colon polyps can become
colon carcinoa
113
what is this showing
carcinoma of the colon
114
a portion of the bowel (along with its mesentery) rotates/twists around itself
volvulus
115
volvulus can cause
obstruction of blood flow to affected bowel
116
3 examples of volvulus
stomach around lesser omentum
sigmoid colon around mesentery
midgut around mesenteric fixation
117
obstruction from volvulus can cause (4)
vascular ischemia
soft tissue swelling
gaseous distension
necrosis
118
what GI symptoms can hypokalemia cause
pseudo-obstruction of bowel
dilation and loss of motility
119
abnormal propulsive activity of the intestines
ileus
120
ileus can involve __ intestinal activity (3)
increased
decreased
absent
121
causes of mechanical obstruction ileus (3)
adhesions
tumor
volvulus
122
ileus dt mechanical obstruction causes __ in intestinal activity
to over come \_\_
and is called \_\_
increase
obstruction
obstructive ileus
123
initially, obstructive ileus causes __ on auscultation,
chronically bowel activity \_\_
active bowel/fluid sounds
decreased
124
t/f ileus is not always an obstructive process
T!
125
ileus can also be 2/2 to an __ inflammatory process
intra-abdominal
126
causes of intra-abdominal inflammatory ileus
appendicitis
cholecystitis
pancreatitis
post-surgical DM
hypokalemia
127
abdominal inflammatory ileus cause intestinal \_\_
or \_\_,
resulting in __ intestinal activity
atony
paralysis
decreased
128
ileus dt intra abdominal inflammation and decreased intestinal activity is called a
paralytic ileus
129
in a paralytic ileus, there will be __ bowel sounds
diminished/absent
130
2 types of ileus
obstructive
paralytic
131
both types of obstructive and paralytic ileus will show __ on plain xray films (2)
dilated air filled loops of bowel
air fluid levels in bowel when pt is upright
132
whenever you see, large dilated loop of bowel, think
volvulus
133
what is this showing
large dilated loop of bowel → **ileus**
134
what is this showing
beak finding of volvulus → proximal distended colon and cecum
135
obstructive vs paralytic ileus is determined by the
h&p -\> auscultation
136
auscultation for obstructive ileus
high pitched, tinging, hyperactive BS
137
auscultation for mechanical ileus
hypoactive/absent bs
138
functional/adynamic ileus is same same
paralytic ileus
139
acute appendicitis is an example of a __ ileus
function/adynamic -\> same same paralytic
