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USMLE
GI Anatomy
| Question | Answer |
|---|---|
| what are the arteries that come off of the celiac trunk? | splenic artery left gastric common hepatic |
| which arteries supply the greater curvature of the stomach? | r/l gastroepiploic |
| which arteries supply the lesser curvature of the stomach? | r/l gastric arteries |
| path of blood from the common hepatic artery | gastroduodenal artery branches off. right gastric artery branches off. common hepatic continues as hepatic artery proper. R/L hepatic arteries branch off of that. cystic artery branches off of R hepatic artery. |
| where are there good, strong arterial anastomoses around the stomach? | R/L gastroepiploics, R/L gastric arteries |
| where is there poor anastomoses to the stomach? | short gastrics (seen when the splenic artery is blocked) |
| what causes esophageal varices? | anastomoses between left gastric vein and azygous vein (portal-caval shunting) |
| what causes caput medusae? | anastomoses between paraumbilical vein and inferior epigastric vein (portal-caval shunting) |
| what causes external hemorrhoids? | anastomoses between superior and inferior rectal veins (portal-caval shunting) |
| what are the causes of portal HTN? | prehepatic: portal/splenic vein obstruction (thrombosis) intrahepatic: cirrhosis, schistosomiasis, tumor posthepatic: CHF, pericarditis, Budd-Chiari syndrome (hepatic vein occlusion) |
| in addition to the occlusions that cause esoph varices, ext hemorrhoids, and caput medusae, what other portal-caval anastamoses occur? | retroperitoneal vein to renal vein, retroperitoneal vein to paravertebral vein |
| where does the blood come from in the inferior epigastric vein? | removes blood from liver via hepatic veins |
| falciform ligament connects contains | liver to anterior abdominal wall, ligamentum teres |
| hepatoduodenal ligament connects contains additional info | liver to duo portal triad (hepatic artery, common bile duct, portal vein) can be compressed b/w thumb and finger to slow bleeding (in epiploic foramen of Winslow) |
| gastrohepatic ligament connects contains additional info | lesser curvature of stomach to liver, gastric arteries, separates R lesser and greater sacs, can be cut during surgery to access lesser sac |
| gastrocolic ligament connects contains additional info | greater curvature of stomach to transverse colon. epiploic arteries in greater omentum |
| gastrosplenic ligament connects contains additional info | greater curvature of stomach to spleen. no arteries. separates L greater and lesser sacs |
| splenorenal ligament connects contains additional info | connects spleen to posterior abdominal wall. splenic artery and vein. none |
| layers of the digestive tract starting closest to lumen? | mucosa (epithelium, lamina propria, muscularis mucosa) submucosa (contains submucosal/Meissner's plexus) muscularis externa (inner circular layer, myenteric/Auerbach's plexus, outer longitudinal) serosa |
| fxn of the lamina propria | support |
| fxn of the muscularis mucosa | motility |
| where is Meissner's plexus located? | within the submucosa, between the muscularis mucosa and the inner circular layer of the muscularis externa |
| where is the Auerbach plexus located? | between the inner circular and out longitudinal layers of muscle |
| fxn of Meissner's plexus | regulates local secretions, blood flow, and absorption. contains cell bodies of some parasympathetic terminal effector neurons |
| fxn of Auerbach's plexus | to coordinate the motility of the gut; contains cell bodies of parasympathetic terminal effector neurons |
| what are the abdominal layers? | “PETTIE: don't be pettie about your abs” peritoneum extraperitoneal tissue transversalis fascia tranversus abdominus internal oblique external oblique |
| where are the only GI submucosal glands | duodenum submucosa, they secrete alkaline mucus to neutralize acid |
| what are Brunner's glands | glands in the duo submucosa that secrete alkaline mucus to neutralize acid. hypertrophied in peptic ulcer dz |
| what is the basal electric frequency of the stomach | 3 Hz |
| what is the basal electric frequency of the duodenum? | 12 Hz |
| what is the basal electric frequency of the ileum? | 8-9 Hz |
| what is the pectinate line | separates the hindgut from the part of the anus that is derived from ectoderm |
| pathology above the pectinate line | internal hemorrhoids (not painful, visceral innervation) adenocarcinoma |
| blood flow above pectinate line | superior rectal artery (branch of IMA) --> inferior rectal vein --> IMV --> portal system |
| blood flow below the pectinate line | inferior rectal artery (branch off of pudendal nerve) --> inferior rectal vein --> internal pudendal vein --> internal iliac vein --> IVC |
| pathology occurring below pectinate line | external hemorrhoids (painful, somatic innervation) squamous cell carcinoma |
| path of bile from liver | bile enters R and L hepatic ducts --> common hepatic duct. flows into cystic duct to enter GB. flows out of GB to enter cystic duct, then common bile duct (inside hepatoduodenal ligament). common bile duct passes behind 1st part of duo and joins wit |
| what is the order (from lateral to medial) of the structures in the femoral triangle? | femoral nerve, artery, vein |
| what is the order from lateral to medial of the structures in the femoral sheath? | femoral artery, vein, deep inguinal lymph nodes (contained in canal) (femoral nerve is not in the triangle) |
| between what 2 structures does the rectus abdmoninus lie? | transversalis fascia, transversus abdominus |
| describe the pathwway leading to an indirect inguinal hernia | internal (deep) inguinal ring. external (superficial) inguinal ring. into scrotum (covered by all three layers of spermatic fascia) |
| where does the indirect inguinal hernia enter the external inguinal ring? | lateral to the inferior epigastric artery |
| describe pathway of direct inguinal hernia | enters at external inguinal ring (covered by transversalis fascia only) |
| what are the layers of spermatic fascia from deep to superficial? | internal spermatic fascia, cremasteric fascia, external spermatic fascia |
| where doe the direct inguinal hernia enter the external inguinal ring | medial to the inferior epigastric artery |
| where is the femoral hernia | below and lateral to the pubic tubercle (women most commonly) |
| what is contained in Hesselbach's triangle? | inferior epigastric artery, lateral border of inferior rectus, inguinal ligament |
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Asclepius
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